* = required fields
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| First Name(s): * |
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| Last Name: * |
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Daytime Phone: *
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| Evening Phone: |
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Email Address: *
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Date of Birth: |
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| SSN: |
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| Do you currently Rent or Own: |
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| Monthly Payment: |
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| How long have you lived here: |
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| Landlord Name & Number: |
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| May we contact your landlord yet? |
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| Pets? Indoor or outdoor? Kind, age & weight: |
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| Are you interested in Renting, Lease Optioning/ Purchasing or Buying? |
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| If applicable, how long would you like to lease before buying the property? |
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| What range would you like to pay as your monthly rent? |
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| Describe what kind of a house you are looking for: |
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| When would you like to move in? |
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| How much could you put down as a deposit/ down payment that would go towards the possible purchase? |
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| Names and ages of others who would live in the house: |
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| Previous address: |
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| Email: * * |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Rent or Own: |
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| Monthly Payment: |
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| How long did you live here: |
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| Landlord Name & Number: |
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| May we contact your landlord yet? |
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| Employment Information A: |
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| Current Employer: |
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| Address/ Phone: |
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| Length of employment: |
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| Position: |
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| Monthly after-tax Income: |
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| Employment Information B: |
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| Current Employer: |
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| Address/ Phone: |
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| Length of employment: |
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| Position: |
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| Monthly after-tax Income: |
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| Have you had any ongoing maintenance issues with your current or previous landlord?: * |
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| Have you had any ongoing disputes or disagreements with your current or previous landlord?: * |
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| Have you ever been sued for rent or evicted from a rental property?: * |
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| Have you ever been convicted of a crime?:: * |
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| Have you ever had a vehicle or home repossessed or filed for bankruptcy protection?: * |
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| References (Name/ Phone/ Address/ Relationship) |
| Reference A: |
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| Reference B: |
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| Reference C: |
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| Other Information |
| How did you hear about us? |
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I authorize ChattanoogaLeaseOption.com to verify
my credit and employment history. |
