Rent to Own Application

Full Name


Current Address



Postal Code

Home Phone

Cell Phone

How did you hear about our program?

Are you currently employed or have a steady income?
 Yes No

Are you self employed?
 Yes No

Employer/Company Name

Position/Title at current job?

How long have you worked there?

How many months or years have you been in this line of work?

Your combined household income (including child benefits)

Total amount of money/cash you have access (ie: savings)

What do you pay in rent now?

How much of a monthly payment can you afford for your own home?

Have you ever filed for bankruptcy?
 Yes No

If yes, did you file alone or with your spouse?
 Yes No

If yes, was it discharged?
 Yes No

If yes, when?

In What areas would you like your new home to be in?

What kind of home would you like?

What price range of home do you think will fit to your budget?

Which is the best time to reach you?

Upon completing the application form a full credit check and or criminal record check may be required.
Incomplete applications will not be processed.