2. Applicant's Name*
4. Please list names of all property owners as shown on deed or land contract.
6. Phone
7. Best Time to Call
9. Email Address
10. Preferred Method of Contact*

    1. Phone
    2. Email
12. Resident Address
14. Street Address
16. Apartment, Suite, or Building
18. City
19. State
20. Zip / Postal Code
22. Mailing Address
    Please fill out only if different from above.
24. Street Address
26. Apartment, Suite, or Building
28. City
29. State
30. Postal / Zip Code
32. How many units are located at this address?*
    -- Select One --1234
34. How long have you owned this property?*
35. How long have you lived at this property?*
37. Fair Market Value
    Please show the Estimated Fair Market Value of your home as stated on your most recent property tax bill. If your property tax bill is sent to your mortgage holder, you may obtain this information by calling the City Assessor’s Office at 920-448-3066.
39. Current Estimated Fair Market Value*
41. Does you property require flood insurance?*
43. What is your average monthly utility cost?*
45. List all debt against the property.*
    Current balance of 1st Mortgage, current balance of 2nd Mortgage, and Down Payment Assistance Loan.
47. Please state all the mortgages against the home, and to whom it is owed.*
    Example: Conventional mortgage or 2nd mortgage, 75,000, XYZ Bank
49. Have you ever received a loan from a city or county agency to improve your property?*

    1. Yes
    2. No
53. Income Of All Persons
55. List the incomes of all persons, 18 years of age or older, who live in your household, including yourself. Income includes, but is not necessarily limited to, income from all gross wages, salaries, commissions, net income from self-employment, net name, relationship to applicant, source of income, and weekly gross amount.*
57. Number of Persons in Household
61. These questions are for Census data purposes. They are not required.
63. Sex of Applicant

    1. Male
    2. Female
64. Age of Applicant
66. Marital Status of Applicant

    1. Single
    2. Married
    3. Divorced
    4. Widowed
67. Handicapped

    1. Yes
    2. No
71. Improvement List
    Following is a list of the most commonly made improvements under our loan programs. If you need one or more of the listed improvements, add a brief explanation in the lines provided after each item. If an improvement you wish to make is not listed here, please describe it in the last category under "Other."
73. Weatherization, Such as Insulation in Walls, Ceiling, or Attic. May Require Replacement of Windows and Doors
75. Remodeling of Unit for Handicap Accessibility
77. Repair Plumbing System, Which May Include Bathroom Fixtures or Water Heater
79. Repair Heating System, Which May Include a New Furnace
81. Repair Electrical System, Which May Include Bringing Service Up to 100 Amps
83. Repair or Replace Roofing or Siding
85. Foundation and Basement Wall Repair
87. Exterior Landscaping
89. Other
Leave This Blank:


91. 1. Receive an email copy of this form.
92. Email address

    This field is not part of the form submission.

93. Submit

* indicates a required field