Property Owner Intake Form Step 1 of 5 20% Please complete all the fields below and we will be in touch shortly with your quote.Property Owner Name(Required) First Name Last Name Email(Required) Phone Number(Required)Property Zip Code(Required) ZIP Code Property Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How did you hear about us?(Required) Are multiple owners on title?(Required) Yes No Property Owner InformationPersonal Information: First Property Owner Property Owner Name(Required) First Last Property Owner Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Cell #(Required)Home #Work #Email Address(Required) Enter Email Confirm Email Social Security Number(Required) Driver's License(Required) Issuing State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPersonal Information: Second Property Owner Second Property Owner Name(Required) First Last Second Property Owner Address(Required) Same as first property owner address? Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Second Owner Cell #(Required)Second Owner Work #Second Owner Home #Second Owner Email Address(Required) Enter Email Confirm Email Second Owner Social Security Number(Required) Second Owner Driver's License(Required) Issuing State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Property InformationWhen do you plan for the house to be ready for occupancy?(Required) What is your current mortgage payment?(Required) What additional services will be included in the rent?(Required) Is there a home warranty?(Required) Yes No Insurance Company(Required) Insurance Company Contact Number(Required)Policy Number(Required) Deductible(Required) Is there an HOA in the neighborhood?(Required) Yes No HOA Company Name HOA Company Contact Number(Required)HOA Services(Required)Please select all HOA services included in the fee Trash collection Grounds maintenance Exterior building maintenance Pest control Pool maintenance Club house Other Other HOA Services(Required) Utility Information(Required)Please indicate what utilities are available at the property. Electricity Water Sewer Gas Trash Collection Other Name of electrical utility company serving the property(Required) Name of water utility company serving the property(Required) Name of sewer utility company serving the property(Required) Name of gas utility company serving the property(Required) Name of trash collection utility company serving the property(Required) Name of other utility company/companies serving the property(Required)If more than one company, please add the utility each company provides in brackets following their name. [e.g.: My-Internet Company (internet)]. Is there a cluster mailbox for the property?(Required) Yes No Location of cluster mailbox(Required) What is the mailbox number?(Required) List any repairs that need to be made List any renovations or improvements made to the property Other NotesPlease list any preferred vendors, specific instructions, deviation from norm, fireplace type (gas/electric/wood burning), etc. Direct Deposit Payment InformationAccount Type(Required) Savings Checking Banking Institution Name(Required) Banking Institution Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Deposit Account Name(Required) Deposit Account Number(Required) Bank Routing Number(Required) Direct Deposit Authorization(Required)Secure Property Management. LLC (SPM) is hereby authorized to directly deposit all payments due to me in the account named herein. I further authorize Secure Property Management, LLC the authority to make debits or take other corrective actions, if necessary, in relation to any deposit made to my account by Secure Property Management. This authorization will remain in effect until I modify or cancel it in writing. I have read and agree to the above stated Direct Deposit Authorization terms.SignatureCAPTCHAUntitledFirst ChoiceSecond ChoiceThird ChoiceEmailThis field is for validation purposes and should be left unchanged.
