Rent to Own Homes
OFFICIAL PURCHASE/REFINANCE QUOTE FORM


Please complete the following information as completely and accurately as possible
General Information

Required Fields*  Valid Characters A-Z a-z 0-9 . , @ # _

Property State : *
Is this a Purchase or Refinance?*    Purchase     Refinance
First Time buyer? Yes    No
Do you have Military Benefits : * Yes    No
Borrower Information
Primary Applicant First Name: *
Primary Applicant Last Name: *
Street Address: *
City: *
State: *
Zip Code: *
Own the home? * Yes No Live Rent Free
Home Phone: * xxxxxxxxxx
Cell Phone:
Current Email Address: *
How would you rate your Credit? * Don't know? Get your FREE CREDIT SCORE
Have you filed Bankruptcy in the last 7 Yrs?* Yes No
Have you had a Foreclosure in the last 7 Yrs?* Yes No
Gross Monthly Income: $ ex.5,000.00
Purchase Information
Are you working with a Realtor? Yes     No
Do you a home picked out? Yes    No
What County will the Property be located?
Property Type? *
Property Use? *
Estimated Purchase Price? * $
Desired new loan amount? * $
Best Time To Contact You:

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