CHF LOAN AND GRANT APPLICATION
BORROWER CO-BORROWER FILE #
For Internal Use Only
CHF LOAN AND GRANT APPLICATION
BORROWER NAME LAST 4 DIGITS OF SSN# CO-BORROWER NAME LAST 4 DIGITS OF SSN#
BORROWERS
MAILING ADDRESS MAILING ADDRESS
CITY STATE ZIP CITY STATE ZIP
HOME PHONE DRIVER’S LICENSE DATE OF BIRTH HOME PHONE DRIVER’S LICENSE DATE OF BIRTH
NAME OF EMPLOYER NAME OF EMPLOYER
EMPLOYER’S ADDRESS EMPLOYER’S ADDRESS
CITY STATE ZIP CITY STATE ZIP
WORK PHONE LENGTH OF EMPLOYMENT WORK PHONE LENGTH OF EMPLOYMENT
YEARS MONTHS YEARS MONTHS
INCOME
POSITION TITLE GROSS MONTHLY INCOME POSITION TITLE GROSS MONTHLY INCOME
$ $
OTHER INCOME SOURCE(S) (Alimony, child support, or separate OTHER INCOME SOURCE(S) (Alimony, child support, or separate
maintenance income need not be revealed if you do not wish to have it maintenance income need not be revealed if you do not wish to have it
considered as a basis for repaying this obligation.) considered as a basis for repaying this obligation.)
SOURCE MONTHLY AMOUNT(S) SOURCE MONTHLY AMOUNT(S)
1. $ 1. $
2. $ 2. $
3. $ 3. $
TOTAL MONTHLY INCOME: $ TOTAL MONTHLY INCOME: $
TOTAL COMBINED MONTHLY INCOME: $
Please complete the following liability information for both the Borrower and Co-Borrower (if applicable) listed on this loan application.
NAME OF MORTGAGE LENDER(S) FOR SUBJECT PROPERTY UNPAID BALANCE MINIMUM MONTHLY PAYMENT(S)
1. $ $
2. $ $
3. $ $
LIABILITIES
OTHER OUTSTANDING DEBT(S): List creditor’s name, unpaid balance, and minimum monthly payment for all outstanding debts, including
automobile loans, credit cards, revolving charge accounts, alimony, child support, separate maintenance, etc. Use continuation sheet if necessary.
COMPANY or CREDITOR NAME(S) UNPAID BALANCE MINIMUM MONTHLY PAYMENT(S)
1. $ $
2. $ $
3. $ $
4. $ $
5. $ $
TOTAL LIABILITIES: $
LIABILITIES CONTINUED…
NO DELINQUENCY/NO DEFAULT ON MORTGAGE OR OTHER LIABILITIES.
Borrower and Co-Borrower are are not currently delinquent or otherwise in default of any of the above listed liabilities.
If Borrower and/or Co-Borrower are currently delinquent or otherwise in default of any of the above listed liabilities, please attach a separate written
statement identifying the delinquency and/or default and providing an explanation of the reasons for the delinquency and/or default.
The CHF Residential Energy Retrofit Program is sponsored by CRHMFA Homebuyers Fund (CHF), a California Joint Powers Authority. Funding for the program is made possible through a
grant award from the Energy Commission Energy Resources Conservation and Development Commission of the State of California. Program restrictions apply. Call for details.
373230.5 Page 1 of 2 08/19/11
CHF LOAN AND GRANT APPLICATION
BORROWER CO-BORROWER FILE #
For Internal Use Only
The following documentation must be submitted to CHF with this CHF Loan and Grant Application:
(1) The Project Financial Analysis Worksheet;
(2) SHPO Contractor Consultation Form;
(3) Energy Usage Data Release Form;
(4) Authorization to Release Property Information;
(5) Home Improvement Contract for the proposed improvements;
(6) HERS “In” Audit Information (Energy Cost Savings and HERS Score Improvement);
(7) Addendum to Home Improvement Contract;
(8) Standard Equipment Cost Documentation;
(9) Verification of Income (current pay-stub or other acceptable proof of current income);
(10) Current Mortgage Statement; and
(11) “Before” Pictures of the Property
SETTLEMENT CHARGES, LOAN TERMS.
If you are approved for a CHF Loan and Grant, the following terms and conditions will apply to the Loan:
(1) The loan amount will be the amount of your Home Improvement Contract, minus any CHF grants, plus the settlement charges and
loan processing fees identified below.
(2) The loan term will be 15 years.
(3) The interest rate will be separately disclosed by CHF. Your interest rate will not change during the term of the loan.
(4) The loan will not be subject to a prepayment penalty and will not have a balloon payment.
(5) The following settlement charges will be added to the loan amount:
$ 110.00 for lender’s title insurance;
$ 25.00 for sub-escrow fee;
$ 90.00 for processing, wire and recording fee;
$ 250.00 for loan processing fee.
CERTIFICATIONS AND AUTHORIZATIONS
I certify that the information in this CHF Loan and Grant Application is complete, true and correct. I understand that I
must be the legal owner of the subject property. I understand that any existing liens on the subject property must be
in good standing to qualify for a loan. I hereby authorize CHF to check my credit and employment history and to
conduct any other investigative inquiry deemed necessary for the purposes of extending credit and the collection of
any amounts owing. CHF is further authorized to conduct all relevant inquiries to determine the current status of liens
and ownership/title to the property, and I hereby authorize all lenders, mortgagees or beneficiaries under any deeds of
trust to discuss the status of any loans and payment history directly with CHF, and to disclose this authorization to any
such party to the extent requested by such party. I authorize CHF to answer questions about its credit experience with
me and to furnish information about my account to consumer reporting agencies and others who may properly receive
that information. I understand that CHF will retain this application whether or not it is approved.
For purposes of processing and facilitating my CHF Loan and Grant, I authorize CHF to share, with the contractor
named in the above referenced Home Improvement Contract (“Contractor”), CHF’s credit decision (whether an
approval or a denial) and any and all information and documentation prepared or delivered in connection with the CHF
Loan and Grant transaction.
I am aware that other weatherization or energy efficiency retrofit programs tailored for low-income and/or moderate-
income households may be available to me, at lower or even no cost. (More information may be obtained from CHF.)
BORROWER’S SIGNATURE DATE CO-BORROWER SIGNATURE DATE
The CHF Residential Energy Retrofit Program is sponsored by CRHMFA Homebuyers Fund (CHF), a California Joint Powers Authority. Funding for the program is made possible through a
grant award from the Energy Commission Energy Resources Conservation and Development Commission of the State of California. Program restrictions apply. Call for details.
373230.5 Page 2 of 2 08/19/11