MY WEALTHY COMMUNITY

National Homeowner Intake Form

Explore the potential value of your home. This form helps us learn about your home, available equity, funds you're seeking, and what you'd like to accomplish.

This is a preliminary intake form only. Completing this form does not guarantee approval, funding, or participation in the program.

↓ Begin the form
1

About You

Best Way to Contact You
2

Your Home

What type of property do you own? *
Is this your primary residence?
3

Estimated Home Value

4

Your Current Mortgage & Equity

Do you currently have a mortgage on the property?
Do you have a HELOC, second mortgage, or other loan secured by the property?
5

How Much Money Are You Seeking?

6

What Would You Use the Money For?

Home repairs include roof, plumbing, electrical, HVAC, foundation, structural repairs, flooring, painting, or other necessary maintenance. Home improvements include kitchen, bathroom, addition, remodeling, landscaping, accessibility improvements, or other upgrades.

Would you use the funds for MORE THAN ONE purpose?
7

When Do You Need the Money?

Is there a specific deadline or event creating your need?
8

Your Ownership of the Home

Are there other people listed as owners on the deed?
9

Property Status

Is your mortgage currently current?
Are your property taxes currently paid and current?
Is the property currently involved in foreclosure?
Are there any other liens, judgments, tax liens, mechanics’ liens, or claims against the property?
Is the home currently listed for sale?
10

Your Future Plans for the Home

Considering selling your home?
Considering refinancing?
Considering a HELOC or home-equity loan?
11

Your Understanding of the Program

MY WEALTHY COMMUNITY may provide qualifying homeowners with access to funds in exchange for contractual participation associated with the future value or equity of the property.

Are you interested in learning more about this type of arrangement?
Do you understand that this may involve sharing some future appreciation or equity?
Would you be willing to provide documentation needed to evaluate the property and ownership?
12

Documents

If your preliminary information indicates that your property may qualify, you may later be asked to provide documentation such as: government-issued ID, property deed, mortgage statement, HELOC/second-mortgage statement, property-tax info, homeowners-insurance info, lien information, property valuation/appraisal, or other documents.

Do you have access to your property and mortgage documents?
13

Your Goals

14

How Did You Hear About MY WEALTHY COMMUNITY?

15

Contact Authorization

May a MY WEALTHY COMMUNITY representative contact you regarding your inquiry? *
Preferred contact method
✓

Applicant Certification

By submitting this preliminary intake form, I confirm that the information I have provided is true and accurate to the best of my knowledge.

  • • This form is an initial inquiry and pre-qualification questionnaire.
  • • Submission does not constitute approval or a commitment to provide funds.
  • • Additional property, ownership, financial, and other documentation may be required.
  • • Any potential transaction will be subject to eligibility requirements, verification, valuation, applicable laws and regulations, and separate written agreements.
  • • I may seek independent legal, tax, and financial advice before entering into any agreement.
  • • I understand that a home-equity participation arrangement may involve sharing in future property appreciation or equity.

Your information is used to evaluate your inquiry and will be handled with care. Submitting this form does not guarantee approval, funding, or participation.