Your Name:		*
Your Email:		*
Last Name:		*
Mailing Address (City, State, Zip):
Best Contact Phone Number::		*
Alternate Phone Number::		*
Location of Desired Rent to Own House:	Bakersfield NW Bakersfield SW Bakersfield NE Bakersfield SE Oildale Las Vegas Taft No Preference	*
Type of House: (Choose one each from a, b, c, d, e)
a):	2 Bedroom 3 Bedroom 4 Bedroom 5 Bedroom or More	*
b):	House Condo Mobile Home	*
c):	500 - 1000 sq ft 1001- 1500 sq ft 1501- 2000 sq ft Over 2000 sq ft	*
If Other, Please Specify:
Monthly rent I can comfortably afford::	$500 or less $750 or less $1000 or less $1250 or less $1500 or less $2000 or less $2500 or more	*
Monthly Household Income:		*
Amount of Cash Deposit I Can Give Today to Hold Property Until Move In:		*
Amount of Cash You Can Put Down at Move In, In Addition to Rent and Deposit:	Less than 5,000 $5,000-$7500 $7,500 - $10,000 $10,000 - $12500 $12,500 - $15,000 $15,000 - $20,000	*
Most Likely Move In Date:		*
How did you hear about us?:	Newspaper Ad Yard Sign Referred by Someone Name of Person Who Referred Me Sign on Pole/Fence Web Search Engine Ad on Sign at Carwash	*
Source of Move In Cash
Select One of the Following::	Bank Account 401k or IRA Sale of Assets Gift/Loan from Family Member Credit Card Cash Advance Settlement ( divorce, lawsuit ) Trust Account Other (Please specify below)	*
Other::
Please List 3 Must Have Requirements for Your Rent to Own Home:		*
Please List 3 Nice to Have Preferences:		*
Reason(s) I Can''t Qualify For a Mortgage::	Not Applicable - I''m prequalified Credit Score Issues Insufficient Income Too Much Debt Length of Employment Can''t Prove Income I Owe Back Child Support Need to Pay Off Liens or Judgements	*
Reason(s) I Want to Rent To Own:	Need Time to Save Up For Down Payment Want to Know the House and Neighborhood Before Buying Need to Move Now But Don''t Have Time to Buy Can''t Qualfiy For a Mortgage Yet	*
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