Rental Application

The undersigned hereby makes an application to rent the following property:

Anticipated move date:

Monthly rent:

Security Deposit:

Please tell us about yourself:

Full Name:

Home Phone:

Date of Birth:

Social Security:

Email Address:

Other Phone:

Dependent 1:

Dependent 2:

Dependent 3:

Dependent 4:

Dependent 5:

List all pets:

Please give residential history (last 3 years)

Current Address:

Aparment #:

City:

State:

Zip:

Month/Year Moved in:

Reasons for Leaving:

Rent $:

Owner/Agent:

Phone:

Previous Address (last 3 years):

Owner/Agent:

Phone:

Please describe your credit history:

Have you declared bankruptcy in the past seven (7) years? No Yes

Have you ever been evicted from a rental residence? No Yes

Have you had two or more late rental payments in the past year? No Yes

Have you ever willfully or intentionally refused to pay rent when due? No Yes

Please provide your employment information:

Your Status: Full Time Part Time Student Unemployed

Employer:

Dates Employed:

Position:

Supervisor Name:

Phone:

Salary:

Per:

(If employed by above less than 12 months, give name & phone of previous employer or school)

If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

Amount $:

Source/Contact Name:

Please list your references:

Banking Accounts:

Account Info 1:

Account Info 2:

Account Info 3:

Personal Reference or Emergency Contact:

Name:

Address:

Phone:

Relationship:

Driver's License:

Your Driver's License Number:

State:

Vehicle Information:

Make/Model:

Year:

License Plate State:

Additional Information:

Please give any additional information that might help owner/management evaluate this application?

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.

I hereby deposit $ as earnest money to be refunded to me if this application is not accepted in 3 business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When so approved and accepted, I agree to execute a lease for months before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.

Authorization: Release of Information

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner/manager.

A $40.00 processing fee must be sent with the application