APPLICATION FOR RE17

Premises Information Today’s Date:__________________

Address6W0DUN6W&OHYHODQG2+44 Monthly Rent $700.00

Move In Date ___________________________ 6HFXULW\Deposit

Pet Deposit 

Personal Information

Applicant’s Name_________________________________________________________

Present Address ________________________________________________________________________

City / State / Zip ____________________________________________________ Phone #_________________

Date of Birth___________________ Social Security #___________________________

Spouse’s Name___________________________________________________________

Date of Birth___________________ Social Security #___________________________

Phone #_________________

Other Occupant’s Name ______________________________________ Relationship_______________

Other Occupant’s Name ______________________________________ Relationship_______________

Rental History

Present Apartment Landlord_________________________________ Landlord’s Phone_________________

Date of occupancy ______________ Rent Paid $_____________

Previous Apartment Landlord ________________________________ Landlord’s Phone_________________

Previous Address________________________________________________________________________

Date of occupancy ______________ Rent Paid $_____________

Employment History

Present Employer__________________________________________ Supervisor ______________ Phone #_____________

Position __________________________________Length of Employment _________________Annual Income __________

Spouse’s Present Employer___________________________________ Supervisor ______________ Phone #_____________

Position __________________________________Length of Employment _________________Annual Income ___________

1
Emergency Contact (Relative or Friend)

Name__________________________________________ Relationship _______________ Home Phone # _______________

Address______________________________ City / State / Zip ______________________ Work Phone #_______________

Miscellaneous

Your E-mail Address: _______________________________________________________________________________

How did you hear about us? __________________________________________________________________________

If resident referral, please give name and address: _________________________________________________________

Do you have any pets? Ƞ YES / ȠNO If yes, please note there is a $200 pet deposit and an additional $25/month pet fee.

Type of Pet: _______________________________ Weight: ________________________ Breed: __________________________

Have you ever filed bankruptcy Ƞ
YES / Ƞ
NO

Have you ever been evicted? Ƞ
YES / Ƞ
NO

Have you ever been convicted of a felony or have any criminal record? Ƞ
YES / Ƞ
NO

Signatures/Authorization
A non-refundable $20processing feeSHUDGXOW is due with the application. This processing fee cannot be applied to rent, pet deposit,
holdingfee or security deposit due. The undersigned does hereby agreeand consent that all information stated on this application may be
verified and processed through a profile reporting agency.

7KHDSSOLFDQWhereby authorizesWKHODQGORUGRUWKHLUUHSUHVHQWDWLYH to conduct any investigation necessary, including but not limited to,
rental history,employment history, credit history and civil and criminal background checks. The applicant also agrees that all information
pertaining to their Senal record can be released for future verification. The applicant hereby releases all parties from liability in connection
with this provision and use of such information. In signing this rental application, the applicant certifies that all information is complete
and accurate. The property applied for cannot be held for the applicant until the entire VHFXULW\GHSRVLWDQGILUVWPRQWK
VUHQW is paid. After
the VHFXULW\GHSRVLWDQGILUVWPRQWK
VUHQW is paid, should the applicant decide not to rent the premises the VHFXULW\GHSRVLWDQGILUVWPRQWK
V
UHQW will be forfeited to the property Owner.

Signature________________________________________________ Date_________________

Spouse’s Signature________________________________________ Date_________________

Office Use Only

Application Taken By: _____________ Date______________ Application Fee Received: _________________________

Date: ______________ Approved/Denied/Cancelled Notified of Approval/Denied letter sent: ______________________

Holding Fee to be paid ____________________ Holding Fee Received ____________________________