STOP RENT Intake Form
Please fill out the form to help us understand your current housing situation and your desired home conditions.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Preferred contact method:
Phone (text & call)
Email
If phone contact chosen, pick preferred time for a call or text (mornings not available):
Early afternoon
Late afternoon
Current Housing Conditions
Do you live in a house or apartment?
How many bedrooms?
How many bathrooms?
How much is your current rent? (in $)
How many people live in your current residence? Specify number of adults and children.
What is your monthly combined income? (in $)
What is your current credit score?
Desired Housing Conditions
How many bedrooms do you need?
How many bathrooms do you need?
How many stories do you want?
Do you prefer a garage?
Attached
Detached
No Preference
What is the most comfortable monthly mortgage payment for you? (in $)
Additional Comments or Preferences
Signature
Please verify that you are human
*
Continue
Continue
Should be Empty: