Pre-Screening Form Pre-Screening Form Name* First Last Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Marital Status*SingleMarriedHave you lived or worked in Charlotte County for the past year?*YesNoHow many ADULTS would be living in the home, including yourself?*How many CHILDREN would be living in the home?*Do you have a source of steady income?YesNoMonthly household income before taxes?*Have you ever been evicted in the past two years?NoYesHow much are you currently paying for rent?*How did you hear about us? This iframe contains the logic required to handle Ajax powered Gravity Forms.