Lahaina Homeowner Recovery Program Interest Form

Aloha, please complete the form below to get on the Lahaina Homeowner Recovery Program interest list.

Upon form submission an email will be sent to you with further program information. Mahalo!

Questions? Please contact kokua@hawaiiancommunity.net

Are you completing this form to receive a free lot survey?

First and Last Name

Phone number

Email

Our emails are often mistaken for JUNK and/or SPAM, please check frequently for email correspondence from us

Mailing Address

Where you CURRENTLY receive mail

Are you a Lahaina homeowner?

What is your current mortgage balance?

$

NUMBERS ONLY PLEASE!

What is your household size?

What is your Annual Household Income?

$

NUMBERS ONLY PLEASE!

What is the condition of your home?

Select...

Have you filed an insurance claim?

Have you received an insurance settlement?

Have you applied for FEMA?

Select...

Have you applied for an SBA Disaster Loan?

How were you referred to this program?

Please share any additional information you feel may be helpful:

Do you need an interpreter?

Captcha (required)

Want to learn more?

Come learn about how the Lahaina Homeowner Recovery Program can help you rebuild and prevent your home from going into foreclosure.

Visit our website using the link below to choose an information session date.