Client Questionnaire


If you’d prefer to, you can print the PDF version and send that by either email or fax. It is located here.

Client Questionnaire Form

Current Living Situation:

Your Full Name
Your Email
Phone Number
Cell Phone
Present Address
Any pets?
Name & relationship of everyone that's going to be living with you:

Current Payments: $
Does it include anything? If yes, what?
Landlord's/manager's name
Landlord Phone
How long have you been at your present address?
When does your current lease expire (if renting)?
When do you have to move by?
Why are you moving?
What are you looking for in a home that you were to eventually buy?

Your Employer
Employer Phone
Position at Company
How long at company?
Gross Monthly Income (before deductions): $
How much down payment can you raise: $
What monthly budget are you trying to work within: $
Credit (choose one):  Good Fair Ugly
Situation: Tell us a little bit about yourself (why are you utilizing Rent to Own to pursue Home Ownership? )
Read and Check this box to agree: I declare that the application is complete true and correct. I further authorize Management or their Authorized Agents to verify the application information including, but not limited to contacting present or former landlords, employers, and personal references, whether listed or not, at the time of the application and at any time in the future, with regards to any agreement entered into with Management. Any false information will constitute grounds for rejection in entering into a rent-to-own, or Management may at any time immediately terminate any agreement entered into in reliance upon misinformation given on the application.
Sign Here:
Today's Date: