Rent-To-Own Home Needed

Required fields are indicated by a *

If you have trouble filling out this form, please call us directly at (704) 370-6419

Source of Call:*	* If Referral, who referred you?
First Name *:	Last Name *:
Address:
Address Line 2:
City:	State:
Zip Code:
Home Phone *: ( )- -
Work Phone: ( )- -
E-mail Address:
Newsletter?
Maximum amount of down payment money available (minimum $3,000 )? *
What home price range are you looking for? *
Maximum monthly payment that's affordable (minimum $1,000.00)? *
What Charlotte area(s) do you want to live in? * CTRL+click to select multiple areas. COMMAND+click for Mac users.
How many bedrooms are required? *
How many bathrooms are required? *
Garage Needed? *
How is your credit? *
When are you ready to move into your new home? *	(mm/dd/yy)
How many square feet are needed?
Other Requirements:
Do you know the MLS #'s (or addresses) of the homes you are interested in seeing? If so, please list.