Fairbanks Neighborhood Housing Services




Intake form

After you have filled out this form, please print this page

Borrower

Name:
SSN:
Mailing address:
Physical address:
Home phone:
Work phone:
Date of birth:
Place of Birth:

Co-Borrower

Name:
SSN:
Home phone:
Work phone:
Date of birth:
Place of birth:

 

Income Information

Borrower:

Name of Employer:
 
Occupation:
Start date:
     
Annual Salary:
$
Please note any other income received per month:
SSI:
$
SSI (dependent(s)):
$
Public assistance:
$
Retirement:
$
Unemployment comp:
$
Assets:
$
Permanent fund dividend:
$
Other:
$

Co-Borrower

Name of Employer:
$
Occupation:
Start date:
$
Annual Salary:
$
Please note any other income received per month:
SSI:
$
SSI (dependent(s)):
$
Public assistance:
$
Retirement:
$
Unemployment comp:
$
Assets:
$
Permanent fund dividend:
$
Other:
$

 

Household Information

Current Housing Arrangement

Household Type

Rent

Homeowner with a mortgage

Do not pay rent

Single Adult

Female-Headed Single Parent

Male-Headed Single Parent

Married Without Children

Married With Children

Two or more unrelated adults

Other

Annual Family Income:
Household size:
Number of Dependants:
Age of Dependants:
Will any non-dependants be living in the home?
Y es N o
Are you or is anyone in your household disabled?
Yes No
Relationship to borrower:
Relationship to co-borrower:
Are you a first time homebuyer? (You have not owned a home in the last three years)
Yes No
Have you been pre-qualified with a lender?
Yes No
Do you have a contract for sale?
Yes No

Referred to Fairbanks Neighborhood Housing Services By :

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Bank

Information for Government Monitoring Purposes

The following information is requested by the Federal Government for certain types of loan applications related to a dwelling, in order to monitor compliance with equal credit opportunity, fair housing and home mortage disclosure laws. You are not required to furnish this information, but are encouraged to do so.

Borrower

I do not wish to furnish this information
Race/National Origin Marital Status Gender
White
Single
Female
Black
Married
Male
Asian or Pacific Islander
Separated
 
American Indian or Alaska Native
Divorced
 
Hispanic
Widowed
 
Other:
   

Education

Less than High School
High School Diploma or GED
Two-Year College
Bachelors Degree
Masters Degree
Doctoral

 

Co-Borrower

I do not wish to furnish this information

Race/National Origin Marital Status Gender
White
Single
Femaile
Black
Married
Male
Asian or Pacific Islander
Separated
 
American Indian or Alaska Native
Divorced
 
Hispanic
Widowed
 
Other
   

Education

Less than High School
High School Diploma or GED
Two-Year College
Bachelors Degree
Masters Degree
Doctoral

Authorization:

I authorize Fairbanks Neighborhood Housing Services, INC. to:

  1. Pull my credit file for housing counseling in connection with my pursuit of a loan to purchase property.
  2. Obtain a copy of my HUD-1 Settlement Statement, Appraisal and Real Estate Note(s), when I purchase a home, from the lender who made me/us a loan and/or Title Company that closed the loan.
  3. I realize that this is not a formal application and the information will be used for prequalification purposes.

___________________________             ____________
BORROWER SIGNATURE                              DATE

___________________________             ____________
CO-BORROWERS SIGNATURE                      DATE

 

After you have filled out this form, please print this page

 

NeighborWorks
534 10th AVE Fairbanks, AK 99701
(phone) 907-451-7230 (fax) 907-451-7236
Hits:
Equal Housing Lender