Let Us Show You How You Can
Rent-to-Own Your Own Home!

Name* Last Name* (Surname)	Day Phone*	Evening Phone
	Cellular #	Best Time to Call*
Email Address*
Street Address*	City*
Province*	Postal Code*
Country* (if other then Canada)	Subdivision Name (if any)
How did you hear about us? Newspaper Ad News Article Street Sign Search Engine Post Card Letter Ad Magazine Flyer Grocery Shopper Car Sign Internet Ad Radio Billboard Business Card Referral Other
Your Property Needs   *What's the most you can afford to pay monthly for your new home? $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,250 $2,500 $2,750 $3,000 $3,250 $3,500 $3,750 $4,000 $4,250 $4,500 $4,750 $5,000+ *What's the most you can you afford to put down on your home? $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000 $7,500 $8,000 $8,500 $9,000 $9,500 $10,000 $12,500 $15,000 $17,500 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000+ *What price range house are you looking for? $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 to $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000+ *How is your credit? Excellent Good Fair Poor Bad No Credit Not Sure *How soon are you looking to purchase your next home? ASAP 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months + *In which area(s) do you wish to purchase your home? *How many bedrooms do you require? 1 2 3 4 5 (+)plus *How many bathrooms do you require? 1 1.5 2 2.5 3 (+)plus *How many square feet do you require? 500 sq ft or more 600 sq ft or more 700 sq ft or more 800 sq ft or more 900 sq ft or more 1000 sq ft or more 1250 sq ft or more 1500 sq ft or more 1750 sq ft or more 2000 sq ft or more 2250 sq ft or more 2500 sq ft or more 2750 sq ft or more 3000 sq ft or more 3250 sq ft or more 3500 sq ft or more 3750 sq ft or more 4000 sq ft or more Not Sure *Do you require a garage? No Yes *Do you require a basement? No Yes *Do you have any other special requirements? Do you have any questions or comments?