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Workforce Housing Preservation Program
Buyer Application
Buyer Details
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County of Placer
East Placer Workforce Housing Preservation Program
3091 County Center Drive, Suite 140
Auburn, CA 95603
East Placer Workforce Housing Preservation Program - Buyer Application
General Information
Applicant Last Name
*
Applicant First Name
*
Applicant Middle Name
Co-Applicant Last Name
Co-Applicant First Name
Co-Applicant Middle Name
Current Mailing Address
*
Current Mailing Address line 2
Current Mailing City
*
Current Mailing State
*
Value is not selected
-- Select one --
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Current Mailing Zip
*
Email Address
*
Email
form field Email Address
is not in correct form
Confirm Email Address
*
Email
form field Confirm Email Address
is not in correct form
Phone
*
Phone
form field Phone
must be in the format: (000) 000-0000
Are you a Home Buyer or Developer?
*
Are you a Home Buyer or Developer?
Home Buyer
Developer
Home Buyer
Age
Form field Age has
Invalid numeric value.
Race
Race
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Total Household Income
*
-- Select one --
$ (USD, US Dollar)
€ (EUR, Euro)
¥ (JPY, Japanese Yen)
£ (GBP, British Pound)
Fr (CHF, Swiss Franc)
$ (CAD, Canadian Dollar)
$ (AUD, Australian Dollar)
$ (HKD, Hong Kong Dollar)
R$ (BRL, Brazilian Real)
$ (CLP, Chilean Peso)
¥ (CNY, Chinese Yuan Renminbi)
Kč (CZK, Czech Koruna)
kr (DKK, Danish Krone)
Ft (HUF, Hungarian Forint)
₹ (INR, Indian Rupee)
Rp (IDR, Indonesian Rupiah)
₪ (ILS, Israeli New Shekel)
₩ (KPW, Korean Won)
RM (MYR, Malaysian Ringgit)
$ (MXN, Mexican Peso)
$ (NZD, New Zealand Dollar)
kr (NOK, Norwegian Krone)
Rs (PKR, Pakistan Rupee)
₱ (PHP, Philippine Peso)
zł (PLN, Polish Zloty)
₽ (RUB, Russian Ruble)
$ (SGD, Singapore Dollar)
R (ZAR, South African Rand)
kr (SEK, Swedish Krona)
T$ (TWD, Taiwan Dollar)
฿ (THB, Thai Baht)
t (TRY, Turkish Lira)
₴ (UAH, Ukraine Hryvnia)
Currency
Form field Total Household Income
requires format 1000.00
Total Household Size
*
Form field Total Household Size has
Invalid numeric value.
Any additional income?
Additional sources of income include child support, alimony, lottery winnings or any additional sources of income not listed here
-- Select one --
$ (USD, US Dollar)
€ (EUR, Euro)
¥ (JPY, Japanese Yen)
£ (GBP, British Pound)
Fr (CHF, Swiss Franc)
$ (CAD, Canadian Dollar)
$ (AUD, Australian Dollar)
$ (HKD, Hong Kong Dollar)
R$ (BRL, Brazilian Real)
$ (CLP, Chilean Peso)
¥ (CNY, Chinese Yuan Renminbi)
Kč (CZK, Czech Koruna)
kr (DKK, Danish Krone)
Ft (HUF, Hungarian Forint)
₹ (INR, Indian Rupee)
Rp (IDR, Indonesian Rupiah)
₪ (ILS, Israeli New Shekel)
₩ (KPW, Korean Won)
RM (MYR, Malaysian Ringgit)
$ (MXN, Mexican Peso)
$ (NZD, New Zealand Dollar)
kr (NOK, Norwegian Krone)
Rs (PKR, Pakistan Rupee)
₱ (PHP, Philippine Peso)
zł (PLN, Polish Zloty)
₽ (RUB, Russian Ruble)
$ (SGD, Singapore Dollar)
R (ZAR, South African Rand)
kr (SEK, Swedish Krona)
T$ (TWD, Taiwan Dollar)
฿ (THB, Thai Baht)
t (TRY, Turkish Lira)
₴ (UAH, Ukraine Hryvnia)
Currency
Form field Any additional income?
requires format 1000.00
Source of additional Income
One month of most recent paystubs for each applicant in household (PDF)
*
Form field One month of most recent paystubs for each applicant in household (PDF) has
Invalid files.
Most recent tax return (2019 or 2020, if applicable)
*
Form field Most recent tax return (2019 or 2020, if applicable) has
Invalid files.
Proof of down payment (One month of bank statement, retirement assets, gift letter, etc)
*
Form field Proof of down payment (One month of bank statement, retirement assets, gift letter, etc) has
Invalid files.
Employer Address
*
Employer Address line 2
Employer City
*
Employer State
*
Value is not selected
-- Select one --
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Employer Zip
*
Do you currently or have you owned any other properties in the last 12 months?
*
Do you currently or have you owned any other properties in the last 12 months?
Yes
No
We require pre-qualification from a Mortgage Lender. Please provide your Pre-Approval letter (upload pdf)
*
Form field We require pre-qualification from a Mortgage Lender. Please provide your Pre-Approval letter (upload pdf) has
Invalid files.
Lender Last Name
*
Lender First Name
*
Lender Phone
*
Phone
form field Lender Phone
must be in the format: (000) 000-0000
Lender Email
*
Email
form field Lender Email
is not in correct form
Are you working with a realtor?
*
Are you working with a realtor?
Yes
No
If so, provide the following Realtor information:
Realtor Last Name
*
Realtor First Name
*
Realtor Phone
*
Phone
form field Realtor Phone
must be in the format: (000) 000-0000
Realtor Email
*
Email
form field Realtor Email
is not in correct form
Buyer down payment contribution ($)
*
-- Select one --
$ (USD, US Dollar)
€ (EUR, Euro)
¥ (JPY, Japanese Yen)
£ (GBP, British Pound)
Fr (CHF, Swiss Franc)
$ (CAD, Canadian Dollar)
$ (AUD, Australian Dollar)
$ (HKD, Hong Kong Dollar)
R$ (BRL, Brazilian Real)
$ (CLP, Chilean Peso)
¥ (CNY, Chinese Yuan Renminbi)
Kč (CZK, Czech Koruna)
kr (DKK, Danish Krone)
Ft (HUF, Hungarian Forint)
₹ (INR, Indian Rupee)
Rp (IDR, Indonesian Rupiah)
₪ (ILS, Israeli New Shekel)
₩ (KPW, Korean Won)
RM (MYR, Malaysian Ringgit)
$ (MXN, Mexican Peso)
$ (NZD, New Zealand Dollar)
kr (NOK, Norwegian Krone)
Rs (PKR, Pakistan Rupee)
₱ (PHP, Philippine Peso)
zł (PLN, Polish Zloty)
₽ (RUB, Russian Ruble)
$ (SGD, Singapore Dollar)
R (ZAR, South African Rand)
kr (SEK, Swedish Krona)
T$ (TWD, Taiwan Dollar)
฿ (THB, Thai Baht)
t (TRY, Turkish Lira)
₴ (UAH, Ukraine Hryvnia)
Currency
Form field Buyer down payment contribution ($)
requires format 1000.00
Type of Funding for Purchase, ie., Conventional, V.A., F.H.A.
*
Applicant Signature
*
Type
Draw
Upload
Clear
Signature
form field Applicant Signature
is required
Co-Applicant Signature
Type
Draw
Upload
Clear
Signature
form field Co-Applicant Signature
is required
Date
*
Date
form field Date
must be in the format: MM/dd/yyyy
Email Address:
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