Second Chance Leasing Intake Form

First Name*

Last Name*

Phone*

Email*

Birthday

What Is Your Facebook Name?

Preferred Method Of Contact

Are You Applying Alone or With Another Adult Co-Applicant?*

How Soon Do You Need To Move?*

Location Preferences:

What Are Your Home Requirements? Any Absolute Must Haves? Bedrooms Needed, Baths Needed, Home Features, Min. Sqft*

Single Family Home

Condo

Duplex

Are You A Section 8 Voucher Holder?

Yes

If Yes, Please Specify Your Housing Authority And Voucher Bedroom Size.

Total Monthly Household Income, Before Taxes? (Include Co-Applicant's Income As Well If Applying With One.)*

What Is Your Max Rent Budget?*

Broken Lease

Current Pending Eviction

Excessive Late Rent Payments

No Prior Rental History Established

Please Provide Details For Each Challenge Above. (Include Date, Amount Owed, Reason, etc.)

What Are Your Current Credit Scores, Roughly? (Include Co-Applicant's Scores As Well, If Applying With One.)*

Have You Or A Co-Applicant Ever Been Convicted Of A Misdemeanor Or Felony? Any Pending Probation Or Parole?*

If Yes, Please Specify Dates, Final Disposition, Outcome, Conviction Type Etc.

Are You Comfortable Paying A Double Deposit Or Risk Fee To Offset Any Of The Above Negatives, If Required?*

Do You Have Pets, Service Animals, Or Emotional Support Animals?*

If Yes, Please Specify Type, Breed, Weight, Age, Quantity, documentation (if applicable).

What Is Your Top Priority In Finding A New Home?*

We'd Love To Know. How Did You Find Us?*

I Understand

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