Contact Information
First Name
*
Last Name
*
Middle Name
Email
*
Phone
*
Home Phone or "Alternative" Phone Number
Address
Address
*
City
*
State
*
Country
*
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
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Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People"S Republic
Korea, Republic of
Kuwait
Kyrgyzstan
Land Islands
Lao People"S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Zip code
*
Previous Address (If less than 2 years at current address)
Personal Information
Date of birth
*
Social Security Number (SSN)
*
What is your preferred language?
*
English
Spanish
Are you a Culinary/Bartender Union Employee?
*
Yes
No
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What is your Race?
*
American Indian/Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than 1 race
Choose not to respond
Not listed
How did you hear about Nevada Partners ?
*
Agency
Co-Worker
Lender
Nevada Partners Community Event
Nevada Partners Website
Real Estate Agent
Bartender/Culinary Union
Walk-in
Word of Mouth
ARE YOU OF HISPANIC ORIGIN?
*
Yes
No
Choose not to respond
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Were you born in a different country?
*
Yes
No
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Marital Status
*
Single
Married
Separated (Not Divorced)
Divocred
Widowed
Domestic Partnership
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Gender
*
Male
Female
Other
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Are you a first time home buyer?
*
Yes
No
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Household Information
What is your household type? (select)
*
Single Adult
Married with Children (In the household)
Female single parent household.
Two or more unrelated adults.
Married without Children (In the household) Two or more adults who are related. (siblings, parents, etc.)
Male single parent household.
Other:
WHAT IS YOUR CURRENT HOUSING ARRANGEMENT?
*
I am a renter.
I own a house with a mortgage.
I am living with family or other alternative living arrangement.
I own a house without a mortgage.
Education:
*
Elementary
Middle School
High School or Equivalent Degree
Some College
Bachelors
Graduate School
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How many in your household? (INCLUDE ALL CHILDREN AND ADULTS WHO CURRENTLY LIVE WITH YOU)
*
Annual Household Income $
*
List the People who depend on You Financially: Examples: Son-10, Daughter-12, Niece-6, Parents-65 & 68, etc.
Are there any non-dependents who will be living in your home after your purchase? If Yes, list below as the examples above.
Submit NPI Housing Intake Form