HOMEOWNER INQUIRY FORM

"Through Shelter, We Empower !"
Please note that this inquiry form is not an application for a Habitat home.

This provides us with your contact information so we can notify you when we have our next Homeownership Opportunities.
NAME(S): *
DATE:

- Month - Day Year
Date
STREET ADDRESS *
APT/UNIT#
PO BOX:
CITY: *
STATE: *
ZIP: *
PREFERRED PHONE: *
ALT. PHONE:
EMAIL:
FAMILY SIZE:
HOW DID YOU HEAR ABOUT HABITAT?
Your information will be kept active in our database for one year. To remain active and to ensure your records are current please re-submit this form each year by January 31st or call the Habitat office at (401) 213-6711. *Be sure to call us immediately if your address changes, so that we may update our records*
Should be Empty: