Rebuilding Together Chattanooga Repair Inquiry
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Are you applying for yourself or someone else? *
How many people live in this home? *
What is the approximate annual household income? Note: Our priority is low income families; therefore, first considerations will be for household incomes below $38,000 for 1 person, $43,400 for 2 people, $48,850 for 3 people, $54,250 for 4 people, $58,600 for 5 people, $62,950 for 6 people, $67,300 for 7 people, and $71,650 for 8 people. *
Homeowner First Name *
Homeowner Last Name *
Homeowner Street Address *
Homeowner City *
Homeowner State *
Homeowner Zipcode *
Homeowner Email Adress
Homeowner Email Telephone Number
Main Contact (if not the Homeowner) First Name
Main Contact (if not the Homeowner) Last Name
Main Contact (if not the Homeowner) Email Address
Main Contact (if not the Homeowner) Telephone Number
What are your most urgent safe and healthy home repair needs? Are there safety concerns? Please provide as much information as possible. *
Are you current on your taxes? *
Are you willing to have volunteers inside your home to make repairs? *
How did you hear about us?
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