NOTICE: *Required Fields *Are you a resident of Buncombe County? Select One Yes No *How much cash do you have on hand? (Enter only whole numbers with no dollar sign or decimal) Next What is the combined balance of all of your checking and savings accounts? (Enter only whole numbers with no dollar sign or decimal) Next Applicant Verification *Ownership Type (select one) Homeowner Renter Other *First Name: Middle/Maiden: *Last Name: *Preferred Language (select one) English Spanish Russian Other *Physical Address Physical Address: *City: *Zip: Mailing Address Same as physical address Mailing Address: City: Zip: Contact Info *Primary Phone: Alternate Phone: **Please note the call you receive regarding this program may come from a blocked number. Email: Tax Bill Number (Optional but will facilitate verification of home ownership): *Do you have children in the home under the age of 18? (select one) Yes No *How many people live in your home? Please include all individuals who are living at the residence, regardless of their relation to the applicant. (select one) 1 2 3 4 5 6 7 8 9 10+ *Gross monthly income of all individuals over 18 for prior month. (Enter only whole numbers with no dollar sign or decimal) Attestation *By checking this box, I certify that all information provided on this inquiry is true and complete to the best of my knowledge. I understand that any false, misleading or incomplete information could impact my eligibility for this program. Submit