Smart Choice Homes Lease To Own Application Form Page 2
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City/
Rent/
Rent/
Address_______________________State/zip___________From______To______ Month$_______
Landlord____________________Address___________________________Phone__________________
Was rent up to date? Y
N
Did you give notice to move? Y
N
Had you been asked to move? Y
N
Why did you move?_____________________________________________________________________
______________________________________________________________________________________
Previous
City/
Rent/
Rent/
Address_______________________State/zip___________From______To______ Month$_______
Landlord____________________Address___________________________Phone__________________
Was rent up to date? Y
N
Did you give notice to move? Y
N
Had you been asked to move? Y
N
Why did you move?
______________________________________________________________________________
______________________________________________________________________________________
EMPLOYMENT HISTORY
Current
Employer: ______________________________________
Address____________________________________________ Date started______________
Type of work you do____________________________Phone #__________________
Hours per week______ Hourly rate _________
Gross Monthly Income___________Supervisor_____________________Supervisor Phone_____________
Previous
Employer: ____________________________________
Address______________________________________ Date started ______ended_____
Type of work you do____________________________Phone #__________________
Hours per week______ Hourly rate _____________
Gross Monthly Income___________Supervisor_____________________Supervisor Phone_____________
Previous
Employer: _____________________________________
Address ________________________________________Date started ______ended________
Type of work you do____________________________Phone #__________________
Hours per week______ Hourly rate ______________
Gross Monthly Income___________Supervisor_____________________Supervisor Phone_____________
LOAN INFORMATION
Vehicle 1
License
Lien
Make/Model/Color_____________________Plate #_______________Holder__________Payment $_____
Vehicle 2
License
Lien
Make/Model/Color_____________________Plate #_______________Holder__________Payment$_____
Credit Card: Visa Master Card Discover Other________________Balance $_________Payment $______
Credit Card: Visa Master Card Discover Other________________Balance $_________Payment $______
Credit Card: Visa Master Card Discover Other________________Balance $_________Payment $______
Credit Card: Visa Master Card Discover Other________________Balance $_________Payment $______
Additional Credit Cards list below.
Other Loans: Name of Creditor___________________Balance_____________Payment $__________
Other Loans: Name of Creditor___________________Balance_____________Payment $__________
Child Support payments? $________________
Additional loans list below. Are payments on all loans current? Y
N
please indicate which are late.
Page 2 of 3 Lease To Own Application
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Parent category: Business