Needs Assessment Form
Please fill in
every
field that is marked with a red asterisk.
General Information - Part 1
Applicant
Co-Applicant
What is your marital status?
Single
Common law
Married
Divorced
Widowed
Why are you looking into a rent-to-own program?
What city are you looking in?
What part of the city?
What kind of home are you looking for?
Bungalow
Two Story
Duplex
Townhome
Number of bedrooms
Number of bathrooms
What else is important to you in your home?
When are you looking to move in to your new home?
Select an answer
1-3 months
3-6 months
6-12 months
1 year plus
Have you selected a house already?
Select an answer
Yes
No
Current Agent
Do you have any pets?
Select an answer
Yes
No
How many pets?
What kind?
How many people will be living in the house?
Adults
Kids
Teens
Financial Assessment - Part 2
Do you currently rent or own?
Rent
Own
Other
If renting, when does your lease expire?
How much is your current rent/mortgage?
What does it include?
How long have you been at your current address?
Select an answer
Less than a year
1-3 years
More than 3 years
How long were you at your previous address?
Select an answer
Less than a year
1-3 years
More than 3 years
What is the maximum monthly payment you could afford towards your new home?
How much do you have for a future down payment?
If no down payment, do you have anything of value?
Select an answer
Yes
No
If yes, please specify.
How is your credit?
Select an answer
Poor, under 600
Decent, 600 plus
Good, 700 plus
Great, 800 plus
If known, what is your credit score?
Occupation - Part 3
Applicant
Are you employed?
Select an answer
Yes
No
Self-employed
Employers or Company name?
For how long?
Co-Applicant
Are you employed?
Select an answer
Yes
No
Self-employed
Employers or Company name?
For how long?
Contact Info - Part 4
Applicant's Name
Applicant's Phone number
Applicant's Email address
Co-Applicant's Name
Co-Applicant's Phone number
Co-Applicant's Email address
Preferred method of contact
Phone Call
Email
Text
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