RENTAL APPLICATION

NAME: NAME:
SOC.SEC: D.O.B. SOC.SEC: D.O.B.
DRIVER LIC. # State: DRIVER LIC. # State:
ADDRESS ADDRESS
ZIP ZIP
TEL:(H) TEL:(H)
(O) (O)
Email: Email:
PRESENT LANDLORD REFERENCE
NAME: NAME:
ADDRESS ADDRESS
TEL:(H) fgfgfgf TEL:(H)
(O) (O)

EMPLOYMENT INFORMATION
EMPLOYER EMPLOYER
DEPT.MANAGER DEPT.MANAGER
ADDRESS ADDRESS
TEL# TEL#
LENGTH OF EMP. LENGTH OF EMP.
SALARY SALARY
POSITION POSITION
MONTHLY RENT:
ADDRESS OF PROPERTIES SHOWN

BANK REFERENCES
Checking Acc#
Savings Acc#

Page1 of 2 Rental Application

 TENANT - BROKERAGE AGREEMENT
I, the undersigned, agree to pay BLOCK & LOT REAL ESTATE SERVICES, INC. a commission of ONE MONTH TO 15% OF
ANNUAL RENT of the demised premise as consideration for obtaining an apartment on my behalf. Payment is to be made
upon completion of the rental agreement between the Landlord and Tenant through BLOCK & LOT REAL ESTATE
SERVICES, INC.

I also understand the apartment(s) shown me by BLOCK & LOT REAL ESTATE SERVICES, INC. and accepted by me as a
result of that showing is NOT the property of BLOCK & LOT REAL ESTATE SERVICES, INC., but rather owned by the
person(s) described to me by BLOCK & LOT REAL ESTATE SERVICES, INC., and therefore that BLOCK & LOT REAL
ESTATE SERVICES, INC. is HELD HARMLESS and is NOT RESPONSIBLE for any apartment in need of repair,
extermination of pests, electrical, gas, plumbing, plastering, painting and cosmetic work, etc. I understand that it is a matter
between Landlord and Tenant and the responsibility of Landlord and Tenant to have such problems rectified by said
Landlord/owner/managing agent prior to, or about the time that I am to occupy said apartment agreed upon by myself and
the Landlord / owner / managing agent.

APPLICANT DATE

APPLICANT DATE

PLEASE READ ALL TERMS BELOW AND SIGN:

I hereby authorize Landlord / Real estate office to obtain information it deems desirable in the processing of my
application, including; credit reports, civil or criminal actions, rental history, employment/salary details, police
and vehicle records, and any other relevant information; and release Landlord, its employees and agents from all
liability for any damage whatsoever incurred in furnishing or obtaining such information.

* CREDIT CHECK FEE IS NONREFUNDABLE UNDER ANY CIRCUMSTANCES *

Signature: Date:

Spouses Signature: Date:

(for office use only)

Member #: Manager’s Approval: Date:

Propery Owner/Manager: Fax Number:

Registry Check Risk Score Wanted Fugitive Search

TRW Credit Report Trans Union credit Report Equifax Credit Report
Please Fax Me the Reports Please Main Me the Reports

Page 2 of 2 Rental Application