Housing Application List

Ticket Number

Date Of Application

Date of Application Score

Please enter a number less than or equal to 3.

1 year or less – 1 pt; 1–5 years – 2 pts; Over 5 years – 3 pts

First Name

Last Name

Date of Birth(Required)

Age Score(Required)

Please enter a number less than or equal to 3.

Under 29 years – 3 pts; 30–35 years – 2 pts; 36–45 years – 1 pt

Home Address

Email Address

Place of Employment

Income Amount(Required)

Income Score(Required)

Please enter a number less than or equal to 1.

Salary below $4,500 – 1 pt

Job Score(Required)

Please enter a number less than or equal to 1.

Employment Sector Government or essential worker 1 pt

Contact Number(Required)

Additional Number

First Name

Last Name

Date of Birth(Required)

Contact Number

Additional Number

Income Amount(Required)

Other

Qualified Amount(Required)

Qualified Amount

If customer has letter for land

Date Pre Qualification letter

Location Requested

Recommendation From:

Additional Scores(Required)

Please enter a number less than or equal to 6.

Total Application Score