1. RENT TO OWN
APPLICATION
Buy Rent to Own Homes LLC
Fax back to 866-302-4604
APPLICANT 1:
Full Name:____________________________________________________________________
SSN:_______________________ Driver License Number:_____________________________
Date of Birth:_________________________
Phone Number (home)____________________________ (work or cell)__________________
Email address: ________________________________________________________________
Current Residence Address:_____________________________________________________
City/State/Zip:_________________________________________________________________
Landlord Name and Phone Number:______________________________________________
How Long? From:__________ To:___________ Rent amount:________________________
Previous Residence Address:_____________________________________________________
City/State/Zip:_________________________________________________________________
Landlord Name and Phone Number:______________________________________________
How Long? From___________ To ____________ Rent amount:________________________
Current Employment/Company Name:____________________________________________
Address:______________________________________________________________________
City/State/Zip:_________________________________________________________________
Supervisor:________________________________Phone Number:______________________
Position:______________________________________________________________________
How Long? From:____________________________ To:______________________________
Income: _______________________ per____________________________________________
If hourly number of hours per week working_______________________________________
Previous/Other Employment/Company Name:______________________________________
Address:______________________________________________________________________
City/State/Zip:_________________________________________________________________
Supervisor:_________________________________ Phone Number:____________________
Position:______________________________________________________________________
How Long? From:_____________________________ To:_____________________________
Income:_________________________per___________________________________________
Property for which you are applying: _____________________________________________
Amount you can put toward the purchase price: $____________
APPLICANT 2:
Full Name:____________________________________________________________________
SSN:_______________________ Driver License Number:_____________________________
Date of birth:______________________________
Phone Number (home)____________________________ (work or cell)__________________
Email Address: ________________________________________________________________
Current Residence Address:_____________________________________________________
City/State/Zip:_________________________________________________________________
Landlord Name and Phone Number:______________________________________________
How Long? From:_______________________ To:___________________________________

2. Previous Residence Address:____________________________________________________
City/State/Zip:_________________________________________________________________
Landlord Name and Phone Number:______________________________________________
How Long? From________________________ To ___________________________________
Current Employment/Company Name:____________________________________________
Address:______________________________________________________________________
City/State/Zip:_________________________________________________________________
Supervisor:________________________________Phone Number:______________________
Position:______________________________________________________________________
How Long? From:____________________________ To:______________________________
Income: _______________________ per____________________________________________
If hourly, number of hours per week working_______________________________________
Previous/Other Employment/Company Name:______________________________________
Address:______________________________________________________________________
City/State/Zip:_________________________________________________________________
Supervisor:_________________________________ Phone Number:____________________
Position:______________________________________________________________________
How Long? From:_____________________________ To:_____________________________
Income:_________________________per___________________________________________
ADDITIONAL OCCUPANTS: List name and relationship including age of minor children
_____________________________________ ________________________________________
_____________________________________ ________________________________________
_____________________________________ ________________________________________
_____________________________________ ________________________________________
EMERGENCY CONTACT (Name and Phone Number)
______________________________
______________________________________________________________________________
PETS (Description and Approximate Weight):________________________________________
______________________________________________________________________________
Vehicle1: (Year/Make/Model):____________________________________________________
License No.____________________________________________________________________
Vehicle 2: (Year/Make/Model):____________________________________________________
License No.____________________________________________________________________
SIGNATURES
I/We certify that the information given herein is complete and correct. The Landlord or seller or his agent is hereby
expressly authorized to verify the accuracy and correctness of these statements, to communicate with my/our present
and former employees, creditors and landlords, and to procure such other information (including credit reports)
which the Landlord/Seller may require to evaluate this application.
Signature:_______________________________________________Date:_________________________________
Signature:______________________________________________ Date:_________________________________