Willamalane Center | 250 S. 32nd St.

, Springfield OR 97478-6302
(541) 736-4544 | willamalane.org

RENTAL APPLICATION
Application Process
We offer application forms to everyone who inquiries about the rental.
We review completed applications in the order in which we receive them.
If we are unable to verify information on an application, the application may be denied.
Screening Guidelines
Complete Application
Each applicant must submit an individual application. Each adult 18 years old or older
qualifies as an individual applicant.
We will not review incomplete applications.
We will accept the first qualified applicant(s).
Identification
Applicants must show one piece of identification that include a photograph and a
current address. Acceptable IDs include a drivers license, military ID, passport, etc
Prior Rental History
Applicants must provide us with the information necessary to contact past landlords.
We reserve the right to deny an application if, after making a good faith effort, we are
unable to verify prior rental history.
Sufficient Income/Resources
Income/resources must be verifiable through pay stubs, employer contact, annuity
statements, current tax records and/or bank statements. Please attach 2 months worth
of pay stubs or proof of income with application. Income must be two times your rent.
Self-employed should provide Schedule C or 1099 to show gross income for most
recent year.
Credit/Criminal/Public Records Check
Credit reports will be evaluated based on a Minimal, Elevated, or Serious Credit Risk
system provided to us by a third party tenant screening company. Applicants are
entitled to a copy of the report provided to us from the screening company. A Serious
Credit Risk report will cause rejection of the application.
Any individual who is a current illegal substance abuser, or has been convicted of the
illegal manufacture, distribution, and/or possession of a controlled substance or
convicted of a felony may be denied tenancy.
Evictions may affect tenancy

Co-Signers:

We do not allow co-signers for applicants.

RENTAL APPLICATION CHECKLIST

Please compile all these items for submission at the same time.

$29.95 application fee for each adult 18 years old or older.

Fully completed and signed Application to Rent for each adult 18 years old
or older.

One form of Valid photo ID for each adult 18 years old or older.
Two (2) paycheck stubs or combination of verification of income as noted
above for each adult applying.
RENTAL APPLICATION PROCESSING FURTHER INFORMATION
No application will be approved if it does not include all requirements.
We acknowledge and abide by all Fair Housing laws and regulations.
If approved, the security deposit will be required within 5 days of notice to hold the
property.
Full rent or the pro-rated amount and any other fees or deposits will be paid upon
signing the rental contract.
Deposit required in certified funds; cash, cashiers check or money order.
Applications will be processed in the order received, first application with all
requirements received equals first considered in approval process.

THANK YOU FOR YOUR APPLICATION!

APPLICATION TO RENT
OWNER TO COMPLETE
Property Address___7575 McKenzie Hwy Springfield OR________________________
Date: ___ /___/

Move-in Date: ______/_____/_________

Rent, Deposit, And Fee Disclosure (Amounts listed below are subject to change before the rental agreement is executed)
Monthly Rent: $ _________________Security Deposit: $________________ Other Deposit: $___________
Landlord may charge the following:
Late Charge of $
Other Fee of $
for ___________________________
Smoke alarm and carbon monoxide alarm tampering fee of $_____________
Dishonored check fee of $25.00 plus amounts charged by bank
Early lease termination fee of $___________
Failure to clean up pet waste, garbage, rubbish or other waste fee of $50.00 per occurrence.
Parking violation or other improper use of vehicle fee of $50.00 per occurrence.
TENANT TO COMPLETE
Applicant Name ____________________________________________________________________________________________
First

Middle

Last

Email Address:________________________________________________ Telephone Number: ___________________________

S.S. #: _____________________________Birth Date: ___________Drivers License, State and#:____________________________
l)

Current Address: _____________________________________City: _______________State:______Zip:__________________

Since: ______________Why are you moving? ______________________________________________________________________

Current Landlord: ________________________Rent Amount$ ___________________ Telephone: ______________________

2)

Previous Address: ____________________________________City: ___________________State:______Zip: _____________

Since: _______________Why did you move?_______________________________________________________________________

Landlord: ____________________________________Rent Amount$ ___________ Telephone: _______________________

Have you ever: Been evicted?
Yes
No; Sued by Landlord?
Yes
No; Filed Bankruptcy?
Convicted, or pleaded guilty or no contest, to a crime?
Yes
No If yes to any of these, please explain:

Yes

No;

_______________________________________________________________________________________________________________

EMPLOYMENT/INCOME
1)

Current Employer:____________________________________________________________ How Long? ________________

Supervisor:
Job Title:

2)

Telephone: ________________
Take home pay (per month): $ ______________

Full-time

Part-time

Current Employer:

How Long? __________________

Supervisor:

Telephone: (

Job Title:
Other Income (per month) $

Take home pay (per month): $______________

Source:

) ______________

Full-time

Part-time

REFERENCES
1)

2)

Emergency Contact:____________________________________________________ Telephone: (

) ______--_________

Personal Reference:____________________________________________________ Telephone: (

) ______--_________

Name

Address

Name

Relationship

Address

Relationship

PERSONAL PROPERTY
1)

Automobile: Make________________Model________Year________

License Plate#___________State ______

2)

Automobile: Make________________Model________Year________

License Plate#___________State ______

3)

Other:__________________________ Model________Year________

License Plate#___________State ______

Do you own the following: Piano/Organ?

Yes

No

Water-filled furniture?

Yes

No

Fish Tank or Aquarium?

Yes

No

APPLICANTS COMMENTS & EXPLANATIONS:

MEMBERS OF HOUSEHOLD
For purposes of identification only, please list names and either ages or dates of birth of other persons to occupy unit:

APPLICANT SCREENING CHARGE DISCLOSURE AND INCOME VERIFICATION

1) Owner/Agent may obtain a credit report, or a tenant screening report which generally consists of:
a) Credit history including credit standing;
b) Public records, including but not limited to judgments, liens, evictions and status of collection accounts;
c) Information verification;
d) Current obligations and credit ratings; and
e) Criminal records.
2) Owner/Agent is requiring payment of an Applicant Screening Charge $29.95, none of which is refundable unless
the Owner/Agent does not screen the applicant. Applications are valid for up to two weeks from date of receipt
by Owner/Agent.
3) Owner/Agent has permission to verify income with current employer(s).
I understand I have the right to dispute the accuracy of any information provided to the Owner/Agent by a screening
service or credit reporting agency with such agencies. I am aware that an incomplete application may cause delays or
result in denial of tenancy. I certify the above information is correct and complete and hereby authorize you to
make any inquiries you feel necessary to evaluate my tenancy and credit standing (including, but not limited to
credit checks). If Owner/Agent is requiring payment of an applicant screening charge, applicant acknowledges
receiving a copy of or reading Owner/Agents Screening Guidelines.

Applicant

Date

Request for Consumer Information

Today's Date:_____________
Consumer name:_____________________________________________
Property/Company applied to: Willamalane Park and Recreation District
Date of application: _______________________________________
I, ________________________ request a copy of any public records provided to the property
listed above by ScreeningWorks, a service of RentGrow Inc., as part of the screening of my
application to that property.
Please send this information by (check one): email

fax

regular mail

(List email address, fax number, OR physical address)

Thank you,
(Please sign)
Note:
A copy of your government-issued ID (ie: state license) must be included with this
request, or no information can be provided.

Please fax this page to: (781) 574-4489

307 Waverley Oaks Rd STE 301

Waltham, MA 02452

(T) 888-401-7999

(E) support@screeningworks.com

www.screenlngworks.com