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RENTAL APPLICATION
E-mail Address to Send Form to
Userid
Prospective Address
Desired Date of Occupancy
Desired Length of Occupancy
Name
Social Security Number
Date of Birth
Reason for Move
Present Address
How Long at This Address
City
State
Zipcode
Phone
   (Numbers Only No Spaces)
Fax
E-mail
Refered By
Driver License Number
Type of Car
License Number
Landlord
Landlords Phone
Previous Address
Previous City
Previous State
Previous Zip
How Long at Previous Address
EMPLOYMENT INFORMATION
Employer
Phone
    ( Numbers Only No Spaces)
Address
Position
How Long
Supervisor
Monthly Income - Take Home Pay
Previous Employer
How Long
SPOUSE OR CO-RENTER INFORMATION
Name
Social Security Number
Date of Birth
Driver License Number
Employer
Position
Address
How Long
Supervisor
Monthly Income Take Home Pay
   
CREDIT REFERENCES
ADDRESS
1  
   
2      
3      
   
PERSONAL REFERENCES
ADDRESS                                          PHONE
1       
2       
3       
   
NEAREST RELATIVE
ADDRESS                                             PHONE
           
   
BANKS
ACCOUNT NUMBER
1      
2  
   
   
VISA/MASTER CHARGE
ACCOUNT NUMBER
1      
2      
   
Have You Ever Been Evicted From Any Tenancy
Yes   No
Have You Ever Willfully and Intentionally Refused to Pay Rent When Due
Yes    No
Do You Know of Anything Which May Interrupt Income or Ability to Pay Rent
Yes    No
   
Do You Own any Real Estate
 Yes   No 
If So, Where and What
 

I HEREBY CERTIFY THAT THE ANSWERS I HAVE GIVEN IN THIS APPLICATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSE ANSWERS OR STATEMENTS MADE BY ME WILL BE SUFFICIENT GROUNDS FOR EVICTION AND LOSS OF ANY SECURITY DEPOSIT. I AGREE TO PAY A NON-REFUNDABLE APPLICATION FEE OF TWENTYFIVE DOLLARS.I AUTHORIZE VERIFICATION OF THE FOREGOING INFORMATION AND THE OBTAINING OF A CONSUMER CREDIT REPORT. FURTHERMORE, IF FOR ANY REASON I BECOME DELINQUENT IN RENTS FEES, DEPOSIT, CHARGES OR COST, YOU ARE HEREBY AUTHORIZED TO USE MY MASTER CARD OR VISA ACCOUNT AND MY AUTHORIZATION IS HEREBY GIVEN.

_____________________________________         _______________________________________

Signature                                                    Date          Signature                                                        Date

A COPY OF THE ABOVE INFORMATION WILL BE SENT TO YOUR E-MAIL ADDRESS AS WELL AT TO THE LANDLORDS. PLEASE SIGN AND DATE THE DOCUMENT AND BRING IT WITH THE APPLICATION FEE TO THE OFFICE OF THE LANDLORD OR HIS AGENT OR YOU MAY SIGN THE DOCUMENT IN THE LANDLORD'S OR HIS AGENT'S OFFICE. NOTE YOUR LANDLORD MAY USE A DIFFERENT OR ADDITIONAL STATEMENT OR PROCEDURE THEN THE ONE ABOVE AND/OR CHARGE A DIFFERENT APPLICATION FEE. PLEASE CHECK WITH YOUR PARTICULAR LANDLORD OR HIS AGENT..
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