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Habitat Home Inquiry Form

*Please note that this inquiry is for the purpose of requesting information only and in no way constitutes as an application for a Habitat Home.  We will notify you by email when applications are available, and you can check our website at www.habitatbentoncountyar.org  

*The information you provide is confidential.  By submitting this inquiry, you agree to allow us to collect the demographic data for statistical purposes only.  Information given is not a representative of the application process and does not constitute either being accepted or declined.  

Contact Information


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Information below is demographic data for statistical purposes only and is not required.