Prequalification Attestation

Customer Information

First Name

Last Name

All people on Deed

Home Phone

Please only enter 10 numerals. No leading 1, ( ) or -

Mobile Phone

Please only enter 10 numerals. No leading 1, ( ) or -

Opt in for Text messages

Preferred Language

How did you hear about this loan program?

What project work are you most interested in for your home?

Property Information

Street Address

City

State

Zip

County

What type of property is this?

Is the property zoned as a condominium on the deed?

Gas Company

Electric Provider

What Fuel type do you use to primarily heat your home?

What Fuel type do you use to primarily heat your hot water?

Do you qualify for income based programs such as fuel assistance?

YesNoUnsure

Have you had an energy assessment in the last 3 years?

YesNo/Unsure

Did you complete the weatherization work recommended in your audit?

What energy efficiency measures are you interested in?

Use ctrl to select multiple values

Do you currently have solar?

Gross Annual Income (From All individuals listed on Deed)

Income attestation must include all income sources for the person(s) listed on the deed only, regardless of household size.
Includes, but not limited to the following: Full or Part-time Employment; Taxable and Non-Taxable Income; Social Security Benefits; Pensions/Retirement funds; Child Support; Alimony; Rental Income; Unemployment/Disability; Public Assistance; Annuities; Trust Funds; Dividends; Death Benefits; Any other Source of Income

Income Categories

Gross Wages (W2) or Contractor (1099-NEC) Income Annual Amount

Investments Income Annual Amount

Other Income Annual Amount

Gross Annual Income of all People Named on Deed

Additional comments you would like to make about your Gross Annual Income

I own the home at the address listed above (I am one of the people listed on the Deed)

I occupy the home at the address listed above (If this is a rental property, owner must occupy at least one unit)

This home is my primary residence (second homes, vacation homes, and short term rentals are not eligible)

Who is the current lending institution for your mortgage?

Are you considering other financing options for these improvements?

I certify the information I have provided about my gross annual income is accurate and true as of the date noted below.

I agree to provide any documentation needed to verify this information, at the request of MassHousing or their implementation vendor(s). I understand that additional documentation will be required by the lender as part of the loan application process. This attestation is to verify eligibility for a home energy assessment and is not a loan application.

I also understand I may be required to repay any incentives I receive if the information I provided about my household income is false or inaccurate.

Lead ID

Record Type ID

Lead Source

Lead Source Detail

Lead Status

Primary Campaign

Company

Date

ESHLP Name