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| First Name:
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| Last Name:
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| Street Address:
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| City:
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| State:
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| Zip:
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| Phone:
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(ex.
xxx-xxx-xxxx)
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| E-mail Address:
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| Are you currently renting:
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When does your lease end:
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| What do you pay in rent today?
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| Your Monthly Affordability:
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How much have you saved for
a downpayment/security deposit?
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| Buying Area:
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(Chicagoland)
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| What size of a place are you looking for?
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| When are you looking to move:
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| Have you had a bankruptcy?
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When?
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| Have you had a foreclosure?
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When?
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| What do you think your credit score is?
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| Are you employed?
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| Another source of income:
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| How did you hear about our Rent-to-Own program?
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