MICHA New Member Application - Merritt Island Cooperative Housing Association

Personal Information

Date(Required)

Applicant’s Name(Required)

First Middle Last

Building(Required)

Unit(Required)

Date of Birth(Required)

SSN#(Required)

Driver’s License # & State(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Number of Vehicles Owned(Required)

New Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current Housing Information

Current Landlord or Mortgage Company(Required)

Contact Name(Required)

Contact Phone(Required)

Date Started(Required)

Date Ended(Required)

Previous Landlord or Mortgage Company

(If current is less that 2 years)

Previous Contact Name

Previous Contact Phone

Date Started

Date Ended

Signature

I understand. the following documents must be submitted with my Application:

* Drivers License/State ID, Social Security card, Vehicle/s Registration and Insurance card.

* Accepted Proof of income: Current letter from; Social Security, SSI, Pension, Annuities.

* 2 years of: Current income tax returns, W-2’s, 1099’s, Unemployment payments.

* Once the application has been received an email will be sent to the applicant(s) with a secure link in which to upload their required documents.

* 1 am fully aware this application will be reviewed by the MICHA Membership Committee.

*I do solemnly swear that the following information is accurate and complete. I acknowledge that any inaccuracies and/or omisions be the basis for immediate cancellation of this application by MICHA.

Signature(Required)

Today’s Date(Required)