Y
N
1. Are you currently employed? 2. Describe your housing status right now? 3. Have you ever had real estate titled in your name? 4. In your opinion how would you rank today's housing prices? 5. Are you a United States citizen? 6. Describe your credit as best you can? 7. What is your housing preference? 8. Do you have a down payment? 9. Select a rent to own monthly payment? 10. Are you in foreclosure or expect it? 11. In the past 2 years have you filed bankruptcy or expect to in the near future? 12. How much knowledge do you have of rent to own programs? 13. Combined Family Income? 14. Are you an U.S. citizen? 15. Best description of your job title? 16. Do you have a major credit card (Visa, MC, Discover)? 17. List (2) zip codes of where you want to live. 18. Do you have a pet(s)? 19. Are you handy with odd job home repairs? 20. How soon will you move to a new home? email:
Please select
Apt.
Co-op
Condo
2 Family (duplex)
Loft
Farm
Mobile
Modular
Multi Family (3 + units)
Single Family
Time Share
Townhouse
Vacation
Other (specify below)
Y
N
Other
Please Select
Bargain Prices
Affordable
Just about right
A bit high
High
Out of reach
N
Y
Please Select
Excellent
Good
Fair
Poor
Unsure
Please select
Apartment
Co-op
Condo
2 Family (duplex)
Loft
Farm
Mobile
Modular
Multi Family (3 + units)
Single Family
Time Share
Townhouse
Vacation
Other (specify below)
Please Select
Under $2000
$2500-3500
$4000-6000
$7000-9000
$10,000-15,000
16,000-20,000
$20,000 -25,000
25,000-30,000
30,000-35,000
35,000-40,000
40,000 -50,000
More than 50,000
Less then $500
$525-625
$650-725
$750-825
$850-925
$950-1050
$ 1100-1200
1250-1400
$1450-1600
$1650-$1800
$1850-2000.
OVER $2000
Y
N
Possibly
Y
N
Possibly
Please select
Nothing at all
A little bit
Average
More than average
Very familiar
Please select
Unemployed
Government Assistance
Retired
Under $10,000
$11,000-20,000
20,001 - 30,000
30,100 - 40,000
40,100 - 50,000
50,100 - 60,000
60,100 - 70,000
70,100 - 80,000
80,100 - 90,000
90,100 - 100, 000
101, 000 - 120,000
121,000 - 140,000
141,000 - 160,000
More than 161,000
Y
N
Y
N
ZIP CODE LOOKUP
DOG
CAT
OTHER
Please select
Nothing at all
A little bit
Average
More than average
Very familiar
Pro Level
Please Select One
Just looking for now
Less than 30 days
30-60 days
60-90 days
90-120 days
For the right deal
Optional: Suggestions/ideas are welcome