| Date |
|
|
| Property |
Address, City
|
| Interested |
Address, City
|
| In |
Address, City
|
|
| Payment |
Rent To Own |
| Method(s) |
Rent |
| Interested In |
Direct Purchase |
|
| Borrower`s Name |
|
| Social Security Number |
SSN will be obtained by phone or in person |
| Employed At |
|
| How Long? |
How Long In Same Line Of Work?
|
| Yearly Gross Income |
Self Employed
Yes No |
| Salary |
Yes No
Commission
Yes No |
| Other Income |
(example - Child Support, Pension, Social Security) |
|
| Co-Borrower's Name |
|
| Social Security Number |
SSN will be obtained by phone or in person |
| Employed At |
|
| How Long? |
How Long In Same Line Of Work?
|
| Yearly Gross Income |
Self Employed
Yes No |
| Salary |
Yes No
Commission
Yes No |
| Other Income |
(example - Child Support, Pension, Social Security) |
|
| Day Phone |
Evening Phone
Cell Phone
|
| Address |
|
| City |
State
ZipCode
|
| How Long? |
Email
|
|
| Currently |
Rent
Own Monthly Payments |
| Overall Credit History |
Excellent
Good
Average
Poor |
| Any Previous Bankruptcy? |
Yes
No
Chapter 7
Chapter 13
Year Discharged |
| Total Monthly Payments |
(not including rent) |
| Collections |
Yes No
Amount of Collections
|
| Auto Payments |
Car 1 per month
Car 2
per month |
| Liquid Assets |
(example - 401K, IRA, CDs, Savings) |
| Down Payment Saved |
|
| Additional Comments |
|
|
|
I give my permission for a credit check
Yes
No |
|
Time frame for move
from to |
|
Do you have a lease to break?
Yes
No |
|
Best time to contact you
|