Application

Do not submit until you have answered every question; if you submit in error and need to resubmit please do so with confidence.

Please Tell Us About Yourself

First Name *

Middle Initial *

Last Name *

Home Phone *

Cell Phone *

Date of Birth *

Social Security # *

Email Address *

Property Choice

Premises to be Leased (check one) *

One Bed Room

Two Bed Room

House

Desired Move In Date *

Tell Us About your Co-Applicant (if applicable)

First Name *

Middle Initial *

Last Name *

Home Phone *

Cell Phone *

Date of Birth *

Social Security # *

Email Address *

Please Give Your Rental History (last 12 months)

Current Address *

Apt, suite, etc.

Country

City

State

Zip code

Move In Date (current address) *

Reason for Leaving *

Monthly Rent Amount *

Owner/Manager (full name) *

Owner/Manager Phone *

Email *

Please Describe Your Credit History (please check one)

Have you declared bankruptcy in the past 7 years? *

Yes

Have you ever been evicted from a rental residence? *

Yes

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

Yes

Have you ever willfully or intentionally refused to pay rent when due? *

Yes

What Is Your Gross Monthly Income? *

$ 1000 or less monthly

$ 1000 to $ 1500 monthly

$ 1500 to $ 2000 monthly

$ 2000 or more monthly

Will You Have the Security Deposit and First Month’s Rent Available Upon Move- In? *

Yes

Need A Payment Solution

* average rent is $ 505 mo * average deposit is $ 400 ( one time)

Do You Have Any Pets? *

Yes

If you answered Yes, please describe pet breed and gender. *

How Many People Will Be Living in the Apartment? *

Only Myself

1 additional person ( 2 total)

2 additional persons ( 3 total)

more than 3 persons

If anyone else will be living with you please include their names and ages in text box. *

Do You Have Any Questions? *

Yes

If you have questions, please ask them in the text box. *

Please enter field that best describes your current situation

Please Provide Your Employment Details

Employer Company Name *

Date Employed *

Position *

Supervisor Name *

Supervisor Phone *

Supervisor Email *

Gross Salary By Year *

Or Hourly Rate If Not On Salary *

Have you been with this employer for less than 6 months? *

Yes

Give Name of Previous Employer *

Previous Employer Phone *

Previous Employer Email *

Please List Your References

Banking (checking account #, where it\'s held) *

Personal Reference # 1 (address, phone, and relationship to person) *

Personal Reference # 2 (address, phone, and relationship to person) *

Personal Reference # 3 (address, phone, and relationship to person) *

Please List your Emergency Contact(s)

Emergency Contact # 1 (address, phone, and relationship to person) *

Please List your Drivers License Information

Drivers License- Applicant (list DL number, expiration date and state of issue): *

APPLICATION DISCLAIMER

AUTHORIZATION Release of Information

I (WE) hereby apply to lease:
the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance.

As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent\’s cost, time, and effort in processing my application.

When so approved and accepted, I agree to execute a lease for
the terms set forth before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason off nonacceptance
which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, and investigative consumer 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.

The above information, to the best of my knowledge, is true and correct.

I agree to permit an investigation of my credit, tenant history, banking and employment for the purposes of renting the home with this owner/manager.

Electronic Application Disclaimer

Electronic contracts and electronic signatures are just as legal and enforceable as traditional paper contracts signed in ink. Federal legislation enacted in 2000, known as the Electronic Signatures in Global and International Commerce act (ESGICA), removed the uncertainty that previously plagued e-contracts.

ELECTRONIC SIGNATURE

APPLICANT Legal Name (full name) *

Today\'s Date *

CO-APPLICANT Legal Name (full name) *

Today\'s Date *

Captcha *

reCAPTCHA is required.

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