Your Contact Information:
First name:
Last name:
Email address:
Phone:	* required
Potential Resident's Information:
Are You the Potential Resident:	Yes No
First Name:	* required
Last Name:
Best way to contact the potential resident:	Phone Email
Phone:	* required
Email:
Date of Birth:
Current Address:
How Long Have You Lived There:
Monthly Payment:
Previous Address:
How Long:
Monthly Payment:
Current Employer:
Employment Length:
Gross Monthly Income:
Previous Employer:
Employment Length:
Gross Monthly Income:
Do you have the following on your record (does not automatically disqualify you if you do):
Eviction:	No Yes (within 2 years) Yes (within 5 years) Yes (5+ years ago)
Foreclosure:	No Yes (within 2 years) Yes (3+ years ago)
Bankruptcy:	No Yes (within 2 years) Yes (2+ years ago)
What are you looking for:
Style:	Single Family House Townhouse Condo Duplex Triplex Apartment (4+ units) Doesn't Matter
Location:	City and location you prefer Example: North Dayton
Bedrooms:	1 2 3 4+
Bathrooms:	1 1.5 2 2.5+
Garage:	No 1 car 2 car Carport Don't care
Basement:	Yes No Don't care
Monthly Payment You Can Afford:	$300-400 $400-500 $500-600 $600-700 $700-800 $800-900 $900-1,000 $1,000-1,100 $1,100-1,200 $1,200-1,300 $1,300-1,400 $1,400-1,500 $1,500-1,600 $1,600-1,700 $1,700-1,800 $1,800-1,900 $1,900-2,000 $2,000+
Security deposit you can afford:	$300-500 $500-1,000 $1,000-1,500 $1,500-2,000
Additional Info:	Any additional information you would like us to know about the potential resident or the specific property you may be interested in.
How Did You Hear About Us: