BFL Down Payment Assistance Applicant Intake

BFL Down Payment Assistance Applicant Intake

Complete this form with your personal, employment, and household details to apply for assistance.
Applicant Intake
Full Name

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous Address (if less than 2 years)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
U.S. Citizen
Special Needs
Authorized to Work in the U.S.
Veteran Status
Household Family Size
Number of Adults
Number of Children
Last 4 Digits of SSN
Dependents
Dependent Name 1

First NameLast Name
Dependent Date of Birth 1

MonthDayYear
Date
Dependent Sex 1

Other
Dependent Name 2

First NameLast Name
Dependent Date of Birth 2

MonthDayYear
Date
Dependent Sex 2

Other
Dependent Name 3

First NameLast Name
Dependent Date of Birth 3

MonthDayYear
Date
Dependent Sex 3

Other
Dependent Name 4

First NameLast Name
Dependent Date of Birth 4

MonthDayYear
Date
Dependent Sex 4

Other
Marital Status and Residence
Marital Status
Residence Type

Other
Rental Information
Landlord Name

First NameMiddle NameLast Name
Landlord Phone
Please enter a valid phone number.Format: (000) 000-0000.
Monthly Rental Payment
Monthly Utilities
Owned a Home Within the Last 3 Years?
How did you hear about our services:

Other
Co-Applicant
Co-Applicant Name

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Marital Status
U.S. Citizen
Veteran
Relationship to Applicant
Last 4 digits of SSN
Government Monitoring
Applicant Race

Other
Applicant Gender

Other
Applicant Highest Education
Co-Applicant Race

Other
Co-Applicant Gender

Other
Co-Applicant Highest Education
Applicant Employment/Income
Employer/Source
Employer/Source Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer/Source Phone
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Years Employed
Date Hired

MonthDayYear
Date
Employment Type
Gross Monthly Income
Additional Income Source 1
Additional Income Source 2
Additional Income Source 3
Total Yearly Income
Co-Applicant Employment/Income
Employer/Source
Employer/Source Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer/Source Phone
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Years Employed
Date Hired

MonthDayYear
Date
Employment Type
Gross Monthly Income
Additional Income Source 1
Additional Income Source 2
Total Yearly Income
Down Payment Assistance
Location
Sales Contract Available
Date of Contract

MonthDayYear
Date
Closing Date

MonthDayYear
Date
Applicant Signature Name

First NameMiddle NameLast Name
Applicant Signature Date

MonthDayYear
Date
Co-Applicant Signature Name

First NameMiddle NameLast Name
Co-Applicant Signature Date

MonthDayYear
Date
Should be Empty:

BFL Down Payment Assistance Applicant Intake

Applicant Intake

Dependents

Marital Status and Residence

Rental Information

Co-Applicant

Government Monitoring

Applicant Employment/Income

Co-Applicant Employment/Income

Down Payment Assistance