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Thursday, 09 September 2010
You are here:
Home
Stimulus Giveaway
Family Name
Address
Address 2
City
Auburn
Bellevue
Black Diamond
Bonney Lake
Bothell
Buckley
Burien
Camp Murray
Carnation
Clyde Hill
Covington
Des Moines
Duvall
Edgewood
Edmonds
Enumclaw
Everett
Fall City
Federal Way
Fife
Hobart
Issaquah
Kenmore
Kent
Kirkland
Lake Forest Park
Lake Stevens
Lakewood
Lynnwood
Maple Valley
Marysville
Medina
Mercer Island
Mill Creek
Milton
Monroe
Mountlake Terrace
Mukilteo
Newcastle
North Bend
Pacific
Paradise Inn
Preston
Puyallup
Ravensdale
Redmond
Redondo
Renton
Sammamish
Seahurst
SeaTac
Seattle
Shoreline
Snohomish
Snoqualmie
Steilacoom
Sumner
Tacoma
Tukwila
University Place
Woodinville
State
WA
Zip Code
Home Phone
Cell Phone
Work Phone
Email
Read the Rules
I have read and agree to the rules regarding this giveaway.
Click for YES
Household Income
Under $15,000
$15,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
Over $100,000
Are you currently employed?
Yes
No
Employer's Name & Phone Number
Do you receive state aid for Foster Care, disability, adoption subsidy or any other benefits of this kind?
Yes
No
Do you have any debt other than your mortgage?
Please list make, model and year of all cars owned by the family:
Please describe what kind of volunteer work or community service the family has been involved in:
Do you have any military experience?
If you are nominating a family, please include your information:
Please summarize your family's CURRENT situation and how it affects you and your home. What makes you deserving? What makes your situation unique?
What are the top repairs that need IMMEDIATE attention? (Please limit your repairs to electrical, plumbing, or heating in nature)
Do you own any other properties?
Are you running a business from your home?
Submit Application
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