Housing Interest Form Before completing this form, please read the information under the "Homeownership" tab. NOTE: THIS IS NOT AN APPLICATION First Name * Last Name * Street Address * City * State * - select - Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northern Mariana Islands Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Postal Code * Email * Phone * Cell Phone Household Information Household Size * Number of Adults (Over 18) * Children's Ages * Marital Status - none - Married Divorced Separated Widowed Single (Never Married) Employer/Work Information Primary Employer * Primary Employer Hourly Rate * Primary Employer Hours Per Week * Secondary Employer * Secondary Employer Hourly Rate * Secondary Employer Hours Per Week * Financial Information Please fill out fields with additional income dollar amountsAlimonyChild Support (Actually Received)DisabilityFamily AssistanceFood StampsSSIOther IncomeOther Income DescriptionType of Bankruptcy - none - None Chapter 7 (Debt Cancellation) Chapter 13 (Repayment Plan) Date of BankruptcyHas the Bankruptcy Been Discharged?Yes No Cancel