Fresh Start Fixes Application

Fresh Start Fixes Application

Discounted services for families, seniors, and small businesses working to rebuild.
Full Name*

First NameLast Name
Business Name (if applicable)
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Service Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Type of Property*

ResidentialCommercialMixed-useNonprofit/Community Organization
Preferred Contact Method*

PhoneEmailText Message
Current Financial Situation*

Fixed income (e.g., Social Security, disability, pension)Low income (below 150% of federal poverty guidelines)Unemployed or underemployedReceiving public assistance (e.g., SNAP, Medicaid, Section 8)Nonprofit or community-based organization with limited fundingSmall business experiencing financial hardshipOther (please explain)
Verification Documents
Requested Services - General Repairs & Maintenance

Minor repairs (doors, windows, locks, trim)Safety upgrades (handrails, lighting, smoke detectors)Accessibility improvements (ramps, grab bars)Painting or patching (interior/exterior)Light plumbing or electrical fixesFence repair or replacementGutter cleaning or repairPorch or step restoration
Requested Services - Cleaning & Curb Appeal

Pressure washing (siding, sidewalks, driveways, storefronts)Window washing (ground level only)Carpet cleaning (residential or commercial)Yard cleanup or light landscapingDumpster pad cleaning or deodorizingSignage cleaning or reinstallationPlanter or seasonal decor setup
Requested Services - Other Needs

Commercial storefront improvementsLight fixture cleaning or bulb replacementHouse number or mailbox replacementOther
Please describe any other requested services or needs here blanks blank
Do you own or rent the property?*

OwnRentLease (Commercial)
Are you a senior (65+)?*

YesNo
Are you a veteran?*

YesNo
Are you disabled or mobility impaired?*

YesNo
Is this property currently occupied?*

YesNoPartially (e.g., vacant unit, closed business)
Are there any safety concerns we should know about (e.g., pets, mold, structural issues)?
Tell us briefly how these services will help you, your family, or your business contribute to the community:
Applicant Signature*

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Date*

MonthDayYear
Date
Printed Name*

First NameLast Name
Should be Empty: