Application

DRAW REQUEST

Borrower's Name:

Phone #:

Cell #:

Address:
Street:

City:

State:

Zip:

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DESCRIPTION OF REPAIRS FOR DRAW

Short Description	Amount
	$
	$
	$
	$
	$
	$
	$
Total	$

Expected completion date for rehab:

I certify that the above repairs have been completed in a safe, sound and sanitary manner. Furthermore, I certify that the house is secure, the yard is mowed and there are no outstanding city/county code violations.

Borrower:

Date: