Second Chance Leasing Intake Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Are You Applying Alone Or With A Co-Applicant?* This field is required.
Please Select
Please Select
Applying Alone
Applying With A Co-Applicant
I Can Apply Alone Or With A Co-Applicant
5
Does Co-Applicant Have Credit Scores Under 600, Criminal Background Concerns, Or Rental History Issues?* This field is required.Please Specify.
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6
Are You A Section 8 Voucher Holder?* This field is required.
YESNO
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What Housing Authority Is Your Voucher With & What Bedroom Size?* This field is required.
8
How Soon Are You Planning To Move?* This field is required.
9
Your Location Preferences?* This field is required.
10
What Are Your Home Requirements?* This field is required.Please Specify How Many Bedrooms And Baths You Need And Any Specific Home Features That Are Requirements For You.
11
Any Pets, Service Animals or Emotional Support Animals?* This field is required.
YESNO
12
How Many Pets, Service Animals or ESA? What Breed? Weight?* This field is required.
13
Desired Property Type?* This field is required.Select All That Apply
Single Family Home
Townhome / Duplex
Condo
Apartment
14
What Is Your Max Rent Budget?* This field is required.
15
Total Household Monthly Income, Before Taxes? Please Include Co-Applicant Income If You'll Be Applying With Someone Else?* This field is required.
16
What Rental History Concerns Do You Have? (SKIP QUESTION, IF NONE OF THESE APPLY TO YOU)Check All That Apply - (LEAVE BLANK IF NONE OF THESE APPLY TO YOU)
17
Please Specify What Rental Concern You Have? Include The Approximate Date, Amount Owed and Reason It Took Place.* This field is required.
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18
What Credit or Financial Challenges Do You Have? (SKIP QUESTION, IF NONE OF THESE APPLY TO YOU)Check All That Apply - (LEAVE BLANK IF NONE OF THESE APPLY TO YOU)
19
Please Specify Which Credit or Financial Challenges You Have? Include Specific Details Relating To Your Credit Challenges* This field is required.
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Ok
20
Do You Have Any Criminal Background Concerns? (SKIP QUESTION, IF NONE OF THESE APPLY TO YOU)Check All That Apply - (LEAVE BLANK IF NONE OF THESE APPLY TO YOU)
21
Please Specify What Charges You Have And The Approximate Disposition Dates?* This field is required.
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Please Provide Any Additional Details About Your Situation:
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Are You Comfortable Paying A Double Deposit or Risk Fee To Help Offset Your Leasing Challenges, If Required?* This field is required.
24
We'd Love To Know. How Did You Find Us?* This field is required.
Should be Empty: