Rent-to-Own Application Step 1 of 5 – Applicant Information 20% Applicant & Co-Applicant InformationApplicant 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 CompanyAre 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? Month Day Year 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 InformationEmployment 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 EmployerCo-Applicant Work Phone Country Phone Number Co-Applicant Length of EmploymentCo-Applicant SupervisorName of Bank (Checking)Name of Bank (Savings) Automatic PaymentsYou can enroll in Autopay. After you receive your coupon booklet you can call and request Autopay information.Authorization & CertificationBY 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 Authorization(Required) I have read and agree to the Authorization & Certification statement above.Co-Applicant Authorization I have read and agree to the Authorization & Certification statement above.Applicant Certification Date(Required) Month Day Year Co-Applicant Certification Date Month Day Year Tenant SignatureTenant Signature(Required)Co-Applicant SignatureCo-Applicant Signature(Required)Applicant SignatureApplicants Signature
