NOAH Foundation Registration Form

The N.O.A.H. Foundation, Inc.

"$how Me the Money!" Application

Information required for determining projected Down Payment Assistance/Grant Funding
(THIS FORM MUST BE FILLED OUT ACCURATELY & COMPLETELY)

Once complete, please submit the form using the button at the bottom. Thank You!

How did you hear about N.O.A.H.?
Registering for next seminar?	Yes No
Requesting immediate assistance?	Yes No
Requesting info on Builder/Developer New Construction Down Payment Assistance (DPA) program?	Yes No
Home Buyer Complete Name: (First Last)
Co-Home Buyer Complete Name: (First Last)
Current Street Address:
City:
State:
Zip Code:
E-mail Address (MUST FURNISH):
Phone Number with Area Code:
Work Phone Number with Area Code:
Fax Number with Area Code:
Employer:
Are you working with a Lender?	Yes No
If "Yes", list the Lender and Loan officer name:
Are you working with a Realtor?	Yes No
If "Yes", list the Real Estate Firm and Agent name:
Do you feel a Realtor is necessary?	Yes No
In what ways do you expect a Realtor and/or Lender to assist you?
Have you OWNED a home within the last 3 years?	Yes No
Current Monthly Rental Payment Amount:
What is your Gross Annual Household Income (before taxes)?
What is the total number of family members in your household?
Estimated purchase price of your new home?
The County & State location of your new home?
Property type desired?	Single-Family Townhome Condo
Have you begun your "Home Search"?	Yes No
If "No", when do you expect to purchase your new home?
What features do you desire in your new home?

Preferred Location:
Other Comments: