Housing Application

HOUSING APPLICATION

1. PROPERTY.

Property(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

2. APPLICANT INFORMATION.

Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Home Phone(Required)

Cell Phone

Work Phone

Date Of Birth

Social Security Number

Driver’s License Number/State

Vehicle Make/Model

Color of Car

Year

License Plate Number

State

3. PROPERTY INFORMATION

Anticipated Move-In Date:

Monthly Payment:

Security Deposit:

Pet Deposit $

Per Pet:

4. HOUSEHOLD INFORMATION.

Please list all full name of all people who will live with you on this property.

Name

First Last

Name

First Last

Name

First Last

Name

First Last

Please list all pets and type:

Pet

Pet Type

Pet

Pet Type

Initials

Tenant

Do you or any of the occupant’s smoke?

Yes

Have you ever been evicted from a rental residence?

Yes

Have you ever been convicted of a crime?

Yes

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

Yes

If yes to any of the above, please explain:

5. RENTAL HISTORY

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dates Lived at Address

Rental Amount

Landlord/Manager

Phone Number

Reason for Leaving:

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dates Lived at Address

Rental Amount

Landlord/Manager

Phone Number

Reason for Leaving:

6. EMERGENCY CONTACT PERSON.

Name

Full Name Relation

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

7. EMPLOYMENT INFORMATION.

Name of Current Employer Name of Supervisor Position Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Date Employed

8. INCOME INFORMATION.

Gross Monthly Wages before deductions

Gross Monthly Amounts of other Income

List Sources of Other Income:

Total Monthly Income

9. APPLICATION FEE

I hereby agree that I have paid $ 35.00 (application fee) for the Broker to process this application which will include, but is not limited to, ordering a credit report, obtaining references, verifying employment and income, and a criminal background check. I understand that this fee is non-refundable if I am not approved to rent this property, nor will it be applied to any rent or security deposit if I am approved to rent this property. In the event I am approved to rent this property, I agree to sign a Rental Agreement within FIVE (5) days of notice of approval. The information that I have provided herein is true and correct, to the best of my knowledge.

Applicant Signature Date

10. Items Needed when housing application is turned in:

a. copies of applicant’s ID and social security cards if applicable. b. money order for application fee $35.00 c. Signed Housing application and filled out no blanks. d. Proof of income at least two months of pay stubs.

EXHIBIT A

AUTHORIZATION Release of Information

I hereby authorize an investigation of my credit, tenant history, banking, employment, income, and criminal background for the purposes of renting a house, apartment, or owner financing property.

Name Of Company

Applicant Name (PRINT)

Applicant Signature Date