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Home Repair Request Form

Contact Us


    Please list the person that will be the main contact for the inquiry.

  • If there is a second person listed on the mortgage, complete homeowner #2 section

  • Household Information

  • List legal name, date of birth, age and relationship to you
    Please note, the repair program requires current homeowner insurance
    Please note, the repair program requires all property taxes to be current.
    Please note, mobile homes do not qualify for this program

    Please answer the questions below to provide Habitat with information about your current housing status, ability to pay for repair services and your willingness to partner with our organization.
  • Drop files here or
    Max. file size: 2 GB.
    Midland County Habitat for Humanity