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Interest Form

Please review the Owner Occupied Rehabilitation Program webpage to ensure you meet our guidelines before submitting this form to HabiJax. Please note that this Interest Form is NOT an application for our ABWK program, but provides us with your information so that we can contact you.

*Are you a resident of New Town or College Gardens?

No

Yes

Do you currently own the home where you live?

No

Yes

*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
Email Address:
Home Phone:
Cell Phone:
What is the best way to reach you? Home Phone Cell Phone Email
Best time to call? Anytime Morning Afternoon Evening
Do you have any liens or judgements on your home?

No Yes I don't know

Does the frame (walls, floors, and/or roof) of your home need any repair or replacement?

Does the frame (walls, floors, and/or roof) of your home need any repair or replacement?

No

Yes

Does the inside of your home need any repair?

No

Yes

Does the exterior of your home need any minor repair, painting, or landscaping?

Does the exterior of your home need any minor repair, painting, or landscaping?

No

Yes

What type of exterior work does your home need::

Landscape Improvements, Sod & Plants

Brush and Debris removal

Minor Fencing Repair

Porch Handrail

Exterior Paint & Caulking

Soffit & Fascia repair

Gutter Repair

Minor Siding and Trim repair

Other (Please Explain)

[if other]:
A promissory note is evidence of a loan.  When HabiJax issues a promissory note, it contains the estimated cost to perform and complete the ABWK construction project.  The promissory note is recorded with the Clerk of the Courts, and is forgivable two years after the ABWK work is complete if the home is not sold in the time frame.

Are you willing to sign a promissory note?

No

Yes

Are you willing to pay the $50.00 administration fee to record the promissory note with the Clerk of the Courts?

Are you willing to pay the $50.00 administration fee to record the promissory note with the Clerk of the Courts?

No

Yes