Rent-to-Own Application

Applicant & Co-Applicant Information

Applicant Name(Required)

First Last

Are You Applying With a Co-Applicant?(Required)

Yes

No

Is the Co-Applicant’s mailing address the same as the Applicant’s?

Yes

No

Co-Applicant Name(Required)

First Last

Applicant Social Security Number(Required)

Co-Applicant Social Security Number(Required)

Applicant Driver’s License Number(Required)

Co-Applicant Driver’s License Number(Required)

Applicant Home Phone

Country Phone Number

Applicant Cell Phone(Required)

Country Phone Number

Co-Applicant Home Phone

Country Phone Number

Co-Applicant Cell Phone(Required)

Country Phone Number

Email Address(Required)

Applicant Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County(Required)

Is this also your mailing address?(Required)

Yes

No

Tenant's Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County(Required)

Co-Applicant Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County(Required)

Years at Current Address(Required)

Do You Own or Rent Your Property?(Required)

Own

Rent

Name of Landlord(Required)

If you rent the property, a Landlord’s Lien Waiver must be signed by your landlord and returned before delivery.

Landlord Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County(Required)

Landlord Phone(Required)

Country Phone Number

Landlord Email(Required)

Mortgage Company

Are You Currently in Bankruptcy?(Required)

If yes, a minimum 30% down payment is required.

Yes

No

Have You Ever Filed Bankruptcy?(Required)

If yes, a minimum 20% down payment is required.

Yes

No

If Yes, When Did You File Bankruptcy?

Please provide three references who do not live in the same household as you.

Reference 1 — Name(Required)

Reference 1 — Relationship(Required)

Reference 1 — Phone(Required)

Country Phone Number

Reference 2 — Name(Required)

Reference 2 — Relationship(Required)

Reference 2 — Phone(Required)

Country Phone Number

Reference 3 — Name(Required)

Reference 3 — Relationship(Required)

Reference 3 — Phone(Required)

Country Phone Number

Employment Information

Employment Status(Required)

Employed

Retired

Employer / Retirement Status(Required)

Work Phone(Required)

Country Phone Number

Type of Business(Required)

Length of Employment(Required)

Supervisor(Required)

Co-Applicant Employer

Co-Applicant Work Phone

Country Phone Number

Co-Applicant Length of Employment

Co-Applicant Supervisor

Name of Bank (Checking)

Name of Bank (Savings)

Automatic Payments

You can enroll in Autopay. After you receive your coupon booklet you can call and request Autopay information.

Authorization & Certification

BY AFFIXING MY (OUR) SIGNATURES BELOW, I (WE) CERTIFY ALL OF THE INFORMATION SUPPLIED BY ME ON THIS FORM IS TRUE AND CORRECT, AND HEREBY AUTHORIZE THE RELEASE OF ANY INFORMATION, DEEMED NECESSARY BY LESSOR, RELATING TO EMPLOYMENT, INCOME, AND EXISTING OR PRIOR LEASES INCLUDING PROPERTY/LANDLORDS. ANY FALSE STATEMENT CAN BE SUFFICIENT BASIS FOR REJECTION OF THIS ORDER. I (WE) HAVE READ AND UNDERSTAND THIS.

Applicant Certification Date(Required)

Co-Applicant Certification Date

Tenant Signature

Tenant Signature(Required)

Co-Applicant Signature

Co-Applicant Signature(Required)

Applicant Signature

Applicants Signature

Applicant & Co-Applicant Information

Please provide three references who do not live in the same household as you.

Employment Information

Automatic Payments

Authorization & Certification

Tenant Signature

Co-Applicant Signature

Applicant Signature

Brandon Sheds

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