Rent to Own has homes and programs available for people wanting to recognize the American Dream of home ownership. If youve had difficulties qualifying for traditional bank loans, we offer alternative methods of buying a home,including lease-optioning and owner financing. Fill in the following form as completely as possible and we will contact you when a home becomes available that meets your purchase criteria. All information provided will be kept strictly confidential (Privacy Policy ).If you dont wish to buy a home now, you can contact us by email with any questions or comments.
Items marked with a red asterisk (* ) are required.
C O N F I D E N T I A L
Your Contact Information
*
First Name
*
Last Name
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Day Phone
*
Evening Phone
Cell/Pager
*
Best Time to Reach You
Anytime
Morning
Afternoon
Evening
Night
Email
Your Property Needs
What kind of Buy/Rent Program are you looking for?
Rent
Rent-to-Own
Buy with Bank Financing
Buy with Owner Financing
Wholesale
Any of the Above
What kind of home are you looking for?
Apartment
Condo
Mobile Home
Single Family Home
Any of the Above
What's the most you can afford to pay monthly for your new home?
$250
$300
$350
$400
$450
$500
$550
$600
$650
$700
$750
$800
$850
$900
$950
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,250
$2,500
$2,750
$3,000
$3,250
$3,500
$3,750
$4,000
$4,250
$4,500
$4,750
$5,000+
What's the most you can you afford to put down on your home?
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
$5,500
$6,000
$6,500
$7,000
$7,500
$8,000
$8,500
$9,000
$9,500
$10,000
$12,500
$15,000
$17,500
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000+
Do you currently have a retirement account with your current employer? IE: 401k, IRA, etc.
Yes
No
N/A
What price range home are you looking for?
$1,000
$5,000
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$375,000
$400,000
$425,000
$450,000
$475,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$950,000
to
$5,000
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$375,000
$400,000
$425,000
$450,000
$475,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$950,000
$1,000,000
How is your credit? Ugly is Ok!
Excellent
Good
Fair
Poor
Ugly
No Credit
How soon are you looking to purchase your next home?
ASAP
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months +
In which area(s) do you wish to purchase your home?
How many bedrooms do you require?
Any
1 or more
2 or more
3 or more
4 or more
5 or more
How many bathrooms do you require?
Any
1 or more
2 or more
3 or more
4 or more
5 or more
How many square feet do you require?
500 sq ft or more
600 sq ft or more
700 sq ft or more
800 sq ft or more
900 sq ft or more
1000 sq ft or more
1250 sq ft or more
1500 sq ft or more
1750 sq ft or more
2000 sq ft or more
2250 sq ft or more
2500 sq ft or more
2750 sq ft or more
3000 sq ft or more
3250 sq ft or more
3500 sq ft or more
3750 sq ft or more
4000 sq ft or more
Do you require a garage?
No
Yes
Do you require a basement?
No
Yes
Do you have any other special requirements?
Do you have any additional questions or comments?
How did you hear about us?
Newspaper
Flyer
Business Card
Sign
Banner
Internet
Referral
Other
If you were referred, please enter the name of the person who referred you.
C O N F I D E N T I A L
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