Expression
of Interest Form
Print out, complete and mail to
PHDC, 1234 Market St., 17th Flr, Philadelphia, PA 19107
Applicant's
Name______________________________Date_____________________
Address________________________City___________State_____Zip
Code_________
Date of Birth___________Social Security #_____-____-______Household
Size________
*Ethnic Origin - Black___ White___ Asian___ Native American___
Latino___ Other______
Home Telephone #__________________Work Telephone #_______________________
Cell Phone #_______________________Annual Income__________________________
Co-Applicant's Name______________________________________________________
Address____________________City_______________State______Zip
Code_________
Date of Birth______/_____/_________Social Security #_______-_____-______________
Home Telephone #___________________Work Telephone #_______________________
Cell Phone #_______________________Annual Income___________________________
Do you or a household member have a disability that requires
accessible housing? Yes_______No______
PHDC has a selection of disabled-accessible houses available
for sale.
Credit Verification
I/We authorize the Philadelphia Housing Development Corporation(PHDC)
to secure any and all information it requires concerning me/us
and
my/our financial affairs and release PHDC, and any and all other
organizations giving said information, of any and all liability.
______________________________ ________________________________________
Signature of Applicant Signature of Co-Applicant
YOU MUST LIST PROPERTY ADDRESS(ES) BELOW TO COMPLETE APPLICATION
OR
THIS REQUEST WILL NOT BE CONSIDERED.
Property Choices
1._________________________________________
2._________________________________________
3._________________________________________
*The U.S.Department of Housing
and Urban Development requires funding recipients to collect
data on the ethnic origin of its clients.
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