We charge a $45 per person or $70 per married couple application fee for credit and criminal background check

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THIS SECTION FOR LANDLORD USE ONLY

Rental Property Address: ________________________________________________________________

Term of Rental: [ ] month to month [ ] lease from _____________ to ______________

Tenant Financial Obligation Prior to Occupancy CONTACT CHECKLIST

First Month's Rent: $____________________ Current Landlord Contacted - Timely Remittance

Security Deposit: $_____________________ [ ] Yes [ ] No

Pet Deposit: $_____________________ Current Employer Verified:

Application Fee: $_____________________ [ ] Yes [ ] No

Credit Report Fee: $_____________________ Credit Report Determination:

Other (specify): $_____________________ [ ] Yes [ ] No

Income Verified (pay stub, employer, etc.) [ ] Yes [ ] No

TOTAL: $_____________________

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DESIRED DATE OF MOVE-IN: ______ / _______ / 20_____

DESIRED LEASE TERM (check one): [ ] 12 months [ ] 6 months [ ] Other (Specify): ______

UNIT TYPE: [ ] 1 BR [ ] 2 BR [ ] 3 BR [ ] Other (Specify): ___________

Name (full legal name): ________________________________________________________________

Social Security Number: ____ ____ ____ - ____ ____ - ____ ____ ____ ____

DOB: _____ / _____ / _____

Home Phone: ____________________________ Work Phone: _______________________________

Driver's License / ID Number: _______________________________________ State: ____________

Name (full legal name): ________________________________________________________________

Social Security Number: ____ ____ ____ - ____ ____ - ____ ____ ____ ____

DOB: _____ / _____ / _____

Home Phone: ____________________________ Work Phone: _______________________________

NAME OF OCCUPANTS AND RELATIONSHIP TO APPLICANT:

Name: ____________________________________________ Relationship: ___________________

Name: ____________________________________________ Relationship: __________________

Name: ____________________________________________ Relationship: __________________

APPLICANT / OCCUPANT VEHICLE(S):

Make: ___________________ Model: ____________ Year: _________ Tag#: _______________

Make: ___________________ Model: ____________ Year: _________ Tag#: _______________

Make: ___________________ Model: _____________Year: _________ Tag#: _______________

EMPLOYMENT HISTORY:

Current Employer:

Name and Address: ________________________________________________________________

Phone: ________________________________ Supervisor: ________________________________

Length of Employment:

Begin ________________ Still employed? (check one) ___ yes ___ no

Previous Employer

Name and Address: _________________________________________________________________

Phone: _____________________Supervisor: ____________________________________________

Length of Employment: Begin ______________ End ______________________

RENTAL HISTORY:

Current Address: __________________________________________________________

Dates Lived at This Address: From ________________ to __________________

Reason for leaving: ________________________________________________________

Landlord/Manager: _____________________________

Landlord/Manager's Phone: _____________________

Previous Address: ________________________________________________________

Dates Lived at This Address: From ________________ to __________________

Reason for leaving: _______________________________________________________

Landlord/Manager: _____________________________

Landlord/Manager's Phone: _____________________

Previous Address: ________________________________________________________

Dates Lived at This Address: From ________________ to __________________

Reason for leaving: _______________________________________________________

Landlord/Manager: _____________________________ Phone: __________________________

INCOME:

Gross Monthly Employment Income Before Deductions: $________________________

Gross Monthly Income From Other Sources (average): $________________________

TOTAL GROSS MONTHLY INCOME: $________________________

CREDIT and FINANCIAL INFORMATION: Bank and Financial Accounts

Checking:

Institution Name _________________________ Branch ____________________ Acct # ___________________

Savings:

Institution Name _________________________ Branch ____________________ Acct # ___________________

Credit Accounts

Credit Card: Type ______________ Amt Owed $__________________

Monthly Payment $_________________

Credit Card: Type ______________ Amt Owed $__________________

Monthly Payment $_________________

Vehicle Loan: Type of Vehicle: ________________________________

Monthly Payment $_________________

Vehicle Loan: Type of Vehicle: ________________________________

Monthly Payment $_________________

Other: Type _______________ Creditor _________________________

Monthly Payment $________________

MISCELLANEOUS: (check appropriate answer)

Do you have pets? _____ yes _____ no If so, describe

___________________________________________________________________________

NOTE: There may be additional fees and/or deposits required for pets housed on premises.

In addition, specific rules and regulations regarding pets may apply.

Do you smoke? _____ yes _____ no

Do you plan to have water filled furniture on the rental property? _____ yes _____ no

If yes, detail below.

______________________________________________________________________________

Have you ever been evicted? _____ yes _____ no If yes, explain below.

Have you ever been convicted of a felony? _____ yes _____ no If yes, explain below.

Have you ever filed for bankruptcy? _____ yes _____ no If yes, explain below.

Explanation:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

APPLICANT PERSONAL REFERENCES:

Name: _____________________________________________

Relationship: ____________________________

Address: ________________________________________________

Phone: ____________________________

Known this reference how long? _______________________

Name: _____________________________________________

Relationship: ____________________________

Address: ________________________________________________

Phone: ____________________________

Known this reference how long? _______________________

Name: _____________________________________________

Relationship: ____________________________

Address: _____________________________________________

Phone: ____________________________

Known this reference how long? _______________________

APPLICANT EMERGENCY CONTACT INFORMATION:

Contact in Emergency (Name): ___________________________________

Relationship:_____________________________ Phone:___________________________

I hereby certify and affirm that all information provided above is true and correct. I fully understand that my lease or rental

agreement may be terminated if I have made any false, misleading or incomplete statement(s) in this application. I

hereby authorize verification of all information provided in this application, including financial and credit information, via

credit bureaus and/or contact with current and previous employers, current and previous landlords and personal

references.

___________________________________________ _______________________________

APPLICANT DATE

__________________________________ ___ ____________________________

CO-APPLICANT DATE