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Home Ownership Application

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Please submit the following online application. If you have any questions, please call (904) 282-7590, ext 204


1. * Last Name:
2. * First Name:
3. MIddle Initial:
4. * Street Address (including apt # or other):
5. * City:
6. * Zip Code:
7. * Home Phone:
8. Cell Phone:
9. * Work Phone:
10. * What is your email address?
11. * Are you a resident of Clay County?
Yes
No
12. * How long?
13. * Marital Status
Single
Married
Divorced
Widow
Widower
14. What is your spouse’s name?
15. Does your spouse work?
Yes
No
16. * Number of Dependents
17. * Who is your employer?
18. * How long have you been employed by them?
19. * Are you disabled?
Yes
No
20. * What is your monthly income?
21. What is your spouse’s income?
22. * Do you receive Social Security income?
Yes
No
23. * Do you receive food stamps?
Yes
No
24. If you receive food stamps, what is the amount?
25. * Do you receive child support?
Yes
No
26. If you receive child support, what is the amount?
27. * Are you a legal resident of the U.S.?
Yes
No
28. * Have you ever been convicted of a felony?
Yes
No
29. * Have you ever filed for bankruptcy?
Yes
No
30. * Have you ever had a home foreclosed?
Yes
No
31. * Describe your current living situation.
32. * What does your credit look like? Do you have any collections, charge-offs, judgments.
33. * What is the best time to contact you?


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