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Home Ownership Programs for People with Blemished Credit
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Lease with the Option to Purchase

A lease-option is a contract in which the property owner and the buyer tenant agree that, at the end of a specified period of time, the tenant buyer has the right to purchase the property for a predetermined and agreed upon price. 
The tenant pays an up-front option fee which represents a percentage of the total purchase price of the property and an additional amount each month will go toward the down payment that will be required. 


First Name:
Last Name:
Middle Name:
Date of Birth:
Social Security Number:
Current Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
Driver's License Number:
Secondary Phone Number:
Personal Information
Expiration Date:
State of Issue:
Employment & Income Information
Current Employer:
Supervisor's Name:
Supervisor's Contact Number:
Employer's Address:
Date Hired:
Your Title or Position:
Gross Income:
Payment Received:

Are you self employed?
What is your Gross Income as stated on your 1099?
What services do you provide?
What is the Name of your Company?
Payment Received:
Employment History
Please list your place employment for the past two (2) years
Supervisor's Name:
Supervisor's Contact Number:
Residential History
Previous Addresses
Landlord's Name
Duration of Residence
Landlord's Contact Number
Additional Information
Do you have Pets or Service Animals?
Do you have a Fish Tank?
Do you have a Waterbed?
What kind of Pets do you have?
How many Pets do you have?
Have you been convicted of a Felony?
Have you ever filed for Bankruptcy?
Have you ever been Evicted?
Do you own a lawn mower?
Duration of Employment
Your Title or Position:
Acknowledgement and Agreement
I agree for Success Realty & Property Management to request my credit report to be used as criteria for qualifying for rental and/or lease options services.
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
I acknowledge that any knowingly false statement will result in an automatic disqualification for renting any of our listed properties.
I have read, understand and agree to the Privacy Policy.