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On line Application Instructions  (for print version, click here)

Fill in as much information as possible. 
Double-check the information  
Press the "submit" button at the end of the form. 
If you do not press the submit button, the completed form will not be received!.
Back to LNDF Homepage or hit the "back" button to go to the previous page.
 

LNDF &  LCLF INTAKE FORM 

1. General Information

Date:

NAME

Social Security #

Date of Birth


 

Co-OWNER/SPOUSE

Social Security #

Date of Birth


STreet ADDRESS or PO Box #

CITY/STATE

ZIP

PHONE # (H)  area code    (W)

Co-applicant (W)

 MOST CONVENIENT TIME TO SET UP AN APPOINTMENT 

MARITAL STATUS:  

DEPENDENTS:
Names:

Ages:

2. Residential  Information

LANDLORD'S NAME

LANDLORD'S PHONE NUMBER

LANDLORD'S ADDRESS

LANDLORD'S CITY/STATE

TIME LIVED AT THE ABOVE ADDRESS MO. RENT $ MO. UTILITIES

IF LESS THAN TWO YEARS, PREVIOUS ADDRESS

3. Employment and Income

EMPLOYER

ADDRESS

PART TIME/Full Time:

LENGTH OF TIME AT CURRENT EMPLOYMENT

HOURly Wages: $

WEEKly income $

MONTHly income: $

YEARly income: $

GROSS MONTHLY INCOME: $

IF LESS THAN TWO YEARS, PREVIOUS EMPLOYMENT

OTHER INCOME SOURCES:     

CHILD SUPPORT MONTHLY     $

PENSION/DISABILITY/SOCIAL SECURITY     $

(APPLICANT) SOURCE:     $

(CO-OWNER/SPOUSE) SOURCE     $

INTEREST ON SAVING    

BANK Name: 

$

OTHER: SOURCE:       $

TOTAL INCOME FROM ALL SOURCES:     $

4. Housing Priorities

1st choice:

city/town

county                          

2nd choice:

city/town

county              

number of bedrooms:

special needs (handicapped, elderly):

have you owned a home in the past three years?

 

are you currently residing in public housing?

are you currently participating in any self-sufficiency program such as project self-sufficiency, etc?

 

If yes, describe the program:

5. 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 opportunity, fair housing and home mortgage disclosure laws.  You are not required to furnish this information, but are encouraged to do so.

bORROWER:

CO-BORROWER

  I DO NOT WISH TO FURNISH THIS INFORMATION

  I DO NOT WISH TO FURNISH THIS INFORMATION

RACE/NATIONAL ORIGIN

RACE/NATIONAL ORIGIN

On-line Applicant 
(for multiple selections, press CRTL/ENTER for each)        
OTHER:

On-line Applicant
  (for multiple selections, press CRTL/ENTER for each)     
OTHER:

SEX:

SEX:


APPLICANT'S SIGNATURE


DATE


CO-APPLICANT'S SIGNATURE


DATE

HOW DID YOU HEAR ABOUT OUR SERVICES?

On-line Applicant       Other:   

Before pushing "submit" please verify that the information is correct.  Once you push submit, the form can not be changed (however, you could fill out the form over again).  If you do not push submit, the information will not be received in our office.