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If you would like to send us an Email, please fill out the Online Form to the right of the page. 

If you would like to contact us via Phone or by Mail, please visit our Contact Us page


123 Street Avenue, City Town, 99999

(123) 555-6789


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Link to read me page with more information.

Critical Home Repair Application

Please note this application does not guarantee that Habitat will perform the repairs. The number of home repairs available is dependent upon organizational resources, funding and volunteer support.


After completing printable application please mail to: Mecosta County Habitat for Humanity/ReStore 18387 Northland Drive, Big Rapids, MI 49307 or Email to

All submissions should include proof of income and of homeownership  

Homeowner's Name *
Homeowner's Name
Address *
Home Phone
Home Phone
Work Phone
Work Phone
Cell/Other Phone
Cell/Other Phone
Date of Birth *
Date of Birth
If you are a VFW or AMVET
Please note, prior application does not disqualify you from participation.
Include income received by/for each person in the household. Please send proof of income to: 18387 Northland Dr Big Rapids, MI 49307. Examples of proof of income: Tax returns, pay stubs, Social Security benefits.
Type of Work Needed *
Check all that apply.
Certification *
By submitting this form, the applicant hereby certifies all information provided in connection with this application is true and correct, and understands that any fraudulent or otherwise intentional misrepresentation may result in criminal and/or civil liability including fines, imprisonment and/or repayment of funds. Please enter your name below. This acts as your electronic signature.
Today's Date *
Today's Date