P.O. Box 3401
Shreveport, Louisiana 71133
Phone:318-621-9263
Fax: 318-636-4914

Apply Here
Membership Application
Membership Application
Fax or email to Sonia Smith
Fax: (318)318-636-4914
Email: ssmith@urhouse.org
Office: (318)621-9263
*User Name:
*Password:
Borrower 1
*Name:
*Address:
*City:
*St:
*Zip:
*Yrs at address:
*Own:
*Rent:
*Married:
Yes
No
*SS#:
DOB:
*Home Ph:
Cell:
Employer:
Yes
No
Position:
Yrs on job:
In line of work:
Gross mo. Income:
Assets: Checking$:
Savings$:
401k/Other$:
Borrower 2
Name:
Address:
City:
St:
Zip:
Yrs at address:
Own:
Rent:
Married:
Yes
No
SS#:
DOB:
Home Ph:
Cell:
Employer:
Yes
No
Position:
Yrs on job:
In line of work:
Gross mo. Income:
Assets: Checking$:
Savings$:
401k/Other$:
o I authorize Urban Housing of America, Inc., LA to pull my consumer credit report :
Borr. 1
Date:
Borr. 2
Date:
Fields marked with an * are compulsory