Home Sale Lease Back Form Question Title * 1. Contact Information Name * Company Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country * Email Address * Phone Number * Question Title * 2. Is the address listed above the property for sale? Yes No Question Title * 3. May we text you at the number provided above? Yes No Question Title * 4. What year was the home built? Question Title * 5. How old is the roof? 3 years or less 3 to 5 years 5 to 7 years 7 to 10 years 10 - 15 years 15+ years Other (please specify) Question Title * 6. Have any improvement's been made to the home? Kitchen Remodel Bathroom Remodel New flooring None Other (please specify) Question Title * 7. When would you like to close? In approximately 30 days In approximately 60 days Other (please specify) Question Title * 8. How long are you interested in renting the house back? The minimum 1 year 1 to 3 years As long as possible Other (please specify) Question Title * 9. Is your home currently being marketed by another Realtor? No Yes, here is a link to the listing. Question Title * 10. What is the asking price for the property? Done