Application Date:

Application ID

APPLICANT INFORMATION

CURRENT ADDRESS

EMPLOYMENT

LANDLORD

APPLICANT'S REFERENCES (OTHER THAN RELATIVES)

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2

1

2

APPLICANT'S BANK REFERENCES

CHECKING

SAVINGS.

CREDIT CARDS/OTHER

CREDIT AND RENTAL HISTORY

Have you declared bankruptcy in the past seven (7) years?

Yes No

Have you ever been evicted or are currently in the process of being evicted?

Yes No

Have you ever been convicted of a felony or crime?

Yes No

Have you had two or more late rental payments in the past year?

Yes No

ADDITIONAL SOURCES OF INCOME

If you have other sources of income for us to consider, please list income, source, and person (banker, employer, etc.) who we may contact. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

1

2

3

4

ADDITIONAL INFORMATION: Please give us any additional information that might help the owner/management to evaluate your application.

AUTHORIZATION

I/we hereby agree that if the application is not approved or accepted by the owner or agent, the application fee and or background check fee, will not be refunded, hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, an investigative consumer/credit report and background report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living as permitted by state law. I also confirm that the information provided is accurate and true, and any lease obtained based on fraudulent information can be terminated at any time throughout the course of lease if it has been determined that fraudulent information has been used for the purposes of obtaining the lease

Date

RELEASE OF INFORMATION

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner, manager, brokerage, finder, agent or leasing company

Date