Rent-To-Own Application

Which Rent-To-Own home(s) are you interested in?

First Name (required)

Middle Name (required)

Last Name (required)

Maiden/Former Name (required)

Cell Phone (required)

Day Phone (required)

Night Phone (required)

Your Email (required)

Driver's License # (required)

State Issued (required)

Date of Birth (Format: 12/12/12) (required)

Desired Move-In Date or Time Frame (required)

What is the Highest MONTHLY Payment you are comfortable paying? (required)

Home Requirements (required)

How would you describe your credit? (required)
---ExcellentGoodFairUgly

Are you willing to enroll in credit repair if the results were guaranteed or your money back (required)
---YesYes, but I have some questionsMaybeNo

How did you hear about us? (required)
---ZillowHot PadsTruliaeBay ClassifiedsvFlyerFacebookCraig's ListGoogle/Internet SearchSignsNeighbor/FriendOther ReferralOther

Current Home Address (Street Address, City, State, Zip Code) (required)

How long have you been at this address? (required)

Current monthly payment? (required)

Name (required)

Phone (required)

Ok to call Landlord to verify Rental History? (required)
---Yes, Landlord is aware I am movingYes, but I would like to provide some details firstNot yet, I need to give my notice firstNo, please see comments section for reason

Why are you moving from your current home? (required)

# of Adults over 18 in Household (required)

# of Children under 18 in Household (required)

List full names & ages of all children

# of Pets (required)

Description of Any Pets (Name, Type, Breed, Age & Weight) (required)

Prior Rental Address (Street Address, City, State, Zip Code) (required)

Prior monthly rent

Name

Phone #

Name (required)

Address (required)

Current Position/Job Title (required)

Gross Monthly Salary (US dollars) (required)

How long at present job? (required)

How long in present line of work/industry? (required)

Employer Contact # to Verify Employment (required)

Other Monthly Income (US dollars)

Describe Source of Additional Income

Have you ever been summoned to court for failure to pay rent? (required)
---NoYes (Please Explain Below)

Have you ever been evicted? (required)
---NoYes (Please Explain Below)

Have you ever been in foreclosure? (required)
---NoYes (Please Explain Below)

Have you ever had your wages garnished? (required)
---NoYes (Please Explain Below)

Have you ever declared bankruptcy? (required)
---NoYes (Please Explain Below)

Have you ever been convicted of a sex crime? (required)
---NoYes (Please Explain Below)

***If Yes to any of the above, please list dates, details (required)

Total credit card(s) balance

Total credit card monthly payment(s)

Car loan balance #1

Car loan monthly payment #1

Car loan balance #2

Car loan monthly payment #2

Total mortgage(s) balance

Mortgage monthly payment(s)

Total student loan balance

Student loan monthly payment(s)

Describe any child support payments you have to pay

If Yes, please explain

Name

Phone

List any other personal references you would like to provide

Additional Comments and/or Questions

Digital Signature (required)

Please type the letters above: