Rent to Own Application

First Name:

Last Name:

SSN:

Date Of Birth:

Present Address:

City:

How Long At Present Address:

Monthly Rent:

Reason For Moving:

Name Landlord:

Phone Landlord:

Present Employer:

Position:

Address:

City State Zip:

Phone:

How Long Have You Worked Here:

Annual Income:

Previous Employer:

Position:

Address:

City State Zip:

Phone:

How Long Have You Worked Here:

Annual Income:

Vehicle:Make Year License Number:

Have You Ever Filed For Bankruptcy:

Do You Have Any Liens Judgments Recorded Against You:

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Co-Applicant Information

First Name:

Last Name:

SSN:

Date Of Birth:

Present Address:

City State Zip:

Present Employer:

Position:

Address:

City State Zip:

Phone:

How Long Have You Worked Here:

Annual Income:

Previous Employer:

Position:

Address:

City State Zip:

Phone:

How Long Have You Worked Here:

Annual Income:

Vehicle:Make Year License Number:

Have You Ever Filed For Bankruptcy:

Do You Have Any Liens Judgments Recorded Against You:

Contact Information

Daytime Phone:

Evening Phone:

Email:

Reference Relative Phone 1:

Reference Relative Phone 2:

Reference Non-Relative Ph 1:

Reference Non-Relative Ph 2:

Previous Address

Previous Address:

City State Zip:

Previous Landlord:

Phone:

How Long At That Address:

Reason For Moving:

Monthly Rent:

Have You Ever Been Evicted:

Property Wanted

Home Mobile Home Investment Property:

No.of Bedrooms:

No.of Bathrooms:

Garage Needed:

Area Location School District:

Yard Needed :

Wanted to Buy Rent To Own:

Owner Financing Required: Yes No

Amount of Down Payment Available:

Monthly Household Income:

Date Needed To Move In:

Number Of People In Household:

Pets Please list:

Other Information

How Did You Hear About Us:

Any Special Requests or Comments:

I certify that all information given is true and correct and I hereby grant Adamark Investments, LLC permission to contact any references listed to verify accuracy of this application and to contact relatives in case of an emergency (incl. non-payment)

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