Assistance Form | Coap Inc.

Housing Assistance

Assistance Form

Applicant
Your Name*
First Middle Intial Last
Your Date of Birth*
Social Security #*
Your Current Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address
- My mailing address is different
Your Mailing Address (If different)
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Tell us about your martial status
- Married
- Separated
- Unmarried (single, divorced, widowed)
Tell us about your Income (Check all that apply)
- Wages
- Other
Your Emplorer
Employee Duration
Your Monthly Income:
Please explain other sources of income:
Add Source(s)
Household Member Name Source of Income Monthly Income
Co-Applicant
Co-Applicant?
- I need to submit Co-Applicant Information
Name*
First Middle Initial Last
Name
First Middle Initial Last
Co-Applicant Date of Birth*
Co-Applicant Date of Birth
Social Security #*
Social Security #
- Address Same as Applicant
Co-Applicant Current Address
Street Address Address Line 2 City State ZIP Code
Mailing Address
- My mailing address is different
Co-Applicant Current Mailing Address(if different)
Street Address Address Line 2 City State ZIP Code
Co- Applicant Phone
Co-Applicant Email
Tell us about your martial status
- Married
- Separated
- Unmarried (single, divorced, widowed)
Tell us about your Income (Check all that apply)
- Wages
- Other
Your Emplorer
Employment Duration
Your Monthly Income:
Please explain other sources of income:
Add Source(s)
Source of Income Monthly Income
Tell us about your additional family members
Tell us about your additional family members
Including yourself, how many people are in your household?*
Household Residents
Name Age Relationship
Tell us about your current housing situation:
Select One
- Own home
- Rent
- Other (explain)
Other housing situation:*
Referral Source
Who can we thank for the referral?*
Select one
- Search Results
- Previous Customer
- Housing Specialist
- Other
Search Engine:
Previous Customer:
Housing Specialist:
Other:
Authorization to Obtain Credit Information
Credit Score
A minimum credit score of 640 is required for our programs.

Alternative Credit
If you have never applied for credit and do not have a score, we are able to obtain and use three (3) alternative forms of credit including: 12-month landlord reference, 12-month utility bills, 12-month cellular phone bills.

Credit Counseling
We also offer free credit counseling to identify credit issues and offer suggestions for improvement that will put you one step closer to achieving your dream of homeownership.
We encourage you to still apply, even if you have credit issues. If this is the case, please select the Delayed Payment Option and explain any known credit issues in the space provided below. Using this option, you will not be charged for a credit report and one of our Housing Specialist will contact you to assist with a credit improvement plan.
Please explain any known credit issues:
AUTHORIZATION TO OBTAIN CREDIT INFORMATION*
I hereby grant permission for COAP,INC to obtain any and all information deemed necessary to process my loan application. This information includes, but is not limited to, my present employment status, my federal income tax returns, if required, my deposit account, my past and present consumer credit record, my mortgage record and/or my rental record.
- I agree
REVERIFICATION AUTHORIZATION TO OBTAIN CREDIT INFORMATION*
COAP,INC, their successors and/or assigns, as their interest may appear may re-verify the information or documents used in processing this loan. I hereby authorize release of information to the lender or its designee, by my employer, bank, accountant, mortgage lender, landlord, creditors, and other sources to verify the accuracy of documents and credit information the lender used in deciding whether to approve the loan.
- I agree
Credit Report Payment Options
*
(Select one of the following options)
- Delayed Payment
- Cash or Money Order
- Pay now with credit card
Delayed Payment Option
- I choose to proceed without paying the processing fee at this time. I understand that my application will not be processed until payment is received and processed.
Cash or Money Order
- I agree to pay with cash (in person only) or money order (by mail or in person). I understand my application will not be processed until payment is received.
By Mail:

Highlands Housing Corporation
Attention: HHC Credit Processing
PO Box 362
London, KY 40738-1738

In Person

London Office
Highlands Housing Corporation
362 Old Whitley Road
London, KY 40743

Monticello Office
Highlands Housing Corporation
110 Stardust Avenue
Monticello, KY 42633
Process my credit payment
- Single Report
- 2 Person Report
I agree to pay the following processing fee. I understand this payment is non-refundable and will be used to offset the cost of the credit report and administrative functions associated with this application.
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Section Break
1st Applicant Signature*
2nd Applicant Signature*

contact us

COAP, INC

301 North Main Street,
Harlan, KY 40831
+1 606-573-9853

Contact Us to learn more!

Contact Form - COAP, INC

Name*
First Last
Email*
Phone
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