Housing Services » 0% Interest Mortgage Program »
Interest Form


Please review the 0% Interest Mortgage 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 a Habitat home, but provides us with your information so that we can contact you.

*First Name:
Middle Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*Have you lived in Jacksonville for at least one year?

Yes No

Email Address:
Home Phone:
Cell Phone:
Work Phone:
*Household Monthly Gross Income:
*Household Size:

Marital Status:

Single

Married

Seperated

Divorced

Widowed

Best Time to Call: 8am-12pm 12pm-4pm 4pm-8pm
How long have you been employed at your current place of work?

How did you hear about HabiJax?

From a HabiJax Homeowner (Enter their name below)

From a Family Member

From a Friend

Church

Public Service Announcement

TV

Radio

Print Media (Ex. Newspaper, Magazine)

Billboard

Bus Advertising

Trade show

United Way

Work

Internet

Construction Sign

Name of HabiJax Homeowner who referred you: