E-Z Grant Request
Submit Form online or
Fax Request to (702) 385-4055
For More Information on the HAC Program call 1-888-729-4824

Main Applicants Information Date: First Name MI Last Name Social Security Number - - Co-Applicant Information First Name MI Last Name Social Security Number - - Contact Information Street Address City State Zip Phone Fax Email Loan Information Have You Already Found A House? Yes No (If Yes) What Is The Sales Price? Have You Been Pre-Approved? Yes No Mortgage Amount Have You Applied For a Loan: Yes No Estimated Grant Needed? Anticipated Closing Date? Lender Information Lenders Name Contact @ Lenders Office Contact Phone & Ext Fax Number Real Estate Broker Information Brokers Name Contact @ Brokers Office Contact Phone & Ext Fax Number Additional Comments Any Additional Comments you may have, please enter here: