Please complete the following application for our repair program. With questions, please contact email@example.com.
Your Name (required)
Your Birthday (required)
Street Address (required)
Zip Code (required)
Phone Number (required)
Your Email (required)
Do you own the property? (required)
If no, who is the homeowner and what is their relationship to you?
Are you current on your property taxes? (required)
Are you current on your mortgage? (required)
YesNoThe mortgage is paid off
Do you have homeowner's insurance? (required)
How many people live in the home? (required)
Is any person residing in your home a Veteran of the United States Armed Services? (required)
Please list all household members and their relationship to you: (required)
Gross Annual Household Income: (required)
Type of structure (i.e. Condo, Mobile Home, Single Detached, Townhome, etc.) (required)
Year it was built: (required)
Please list the type of repair work needed: (required)
Please upload the following documents for your application to be processed.
Income verification (include all that apply):
Copy of most recent Real Estate Property Tax Statement marked PAID (required)
Copy of Homeowners Insurance Declarations page (required)
Copy of most recent mortgage statement
Copy of last three month's bank statements (required)
Serving Marion, Hendricks and Hancock Counties.
© 2017 Habitat for Humanity of Greater Indianapolis.