Form
Owner Name
*
As reflected on property records.
Address
*
Street Address
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Payment Method
*
Check
EFT (electronic funds transfer)
Other
Is the Owner an individual or a company?
*
Individual
Company
If a Company, what kind?
Estate
Corporation
Limited Liability Company (LLC)
Trust
Partnership
Limited Liability Partnership (LLP)
Other
State where Company was created:
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Company Contact Name
Company Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Inability to Contact Owner
If Broker is unable to contact Owner for 3 days, Broker is authorized to contact the person below for the sole purpose of attempting to reestablish contact with Owner.
Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Rental Property
Property Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Type of Property
*
Single Family
Condo or Townhome
Duplex
Multiplex
Other
Number of Units
If Applicable
The property is currently:
*
Vacant
Occupied by the owner
Occupied by tenants with no plans to vacate
Occupied by tenants planning to vacate
Unknown
Animals/Pets
*
Not permitted
Permitted
Permitted with restrictions
Animal Restrictions
Cat
Dog - small
Dog - large
Other
Number of Animals Permitted
Animal Charges
A refundable pet deposit, in addition to the security deposit.
A monthly pet charge.
A one-time, non-refundable payment.
Other
Utilities
All utilities will be paid by Tenant except the above.
Yard Maintenance Responsibility
Landlord
Tenant
Contractor chosen and paid by Tenant
Sprinklers
Yes
No
Pool/Spa
Yes
No
Pool/Spa Maintenance Responsibility
Landlord
Tenant
Contractor chosen and paid by Tenant
Is the property part of an HOA?
Yes
No
Name of HOA
HOA Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Appliances included in the house:
Range
Microwave
Dishwasher
Refrigerator
Washer & Dryer
Air Conditioner
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Insurance
Is the property insured?
*
Yes
No
Insurance Company
Coverage Amount
We recommend no less than $500,000.00 on an occurrence basis.
Agent
Agent Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mortgage
Does the property have a mortgage?
*
Yes
No
Mortgage Company
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Property Resources
Electricity
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Water/Trash
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Cable/Internet
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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