APPLICANTS INFORMATION

First Name: ________________________ Middle: ______________________ Last: ________________________

Present Address: _____________________________ City: ___________________ St: ____ ZIP Code: ________

Landlord/Mortgage Co.: ______________________________________________ Phone ##: _________________

From: __________ (mm/yy) To: __________ (mm/yy)          Monthly Payment: _____________

Soc. Sec. ##: ________________ Date of Birth: ________________

Have you ever been evicted or asked to move out of an apartment or home? Yes No

Have you ever been convicted of a felony? Yes No   Marital Status: Single Married

Home Phone ##: _________________ Work Phone ##: _________________

Mobile ##: _________________ E-mail Address: ____________________________________________________

Applicant's Drivers License ##: ____________________________________ State Issued: ______

Applicant's Present Employer: _________________________________________ Monthly Income: __________

Position/Department: _____________________________ From: __________ (mm/yy) To: __________ (mm/yy)

Supervisor's Name: ____________________________________ Supervisor's Phone ##: _________________ *Please provide check stubs for verification

Applicant's Previous Employer: _________________________________________ Monthly Income: __________

Position/Department: _____________________________ From: __________ (mm/yy) To: __________ (mm/yy)

Supervisor's Name: ____________________________________ Supervisor's Phone ##: _________________

SECOND APPLICANT (spouse/roommate)

First Name: ________________________ Middle: ______________________ Last: ________________________

Present Address: _____________________________ City: ___________________ St: ____ ZIP Code: ________

Landlord/Mortgage Co.: ______________________________________________ Phone ##: _________________

From: __________ (mm/yy) To: __________ (mm/yy)          Monthly Payment: _____________

Soc. Sec. ##: ________________ Date of Birth: ________________

Have you ever been evicted or asked to move out of an apartment or home? Yes No

Have you ever been convicted of a felony? Yes No   Marital Status: Single Married

Home Phone ##: _________________ Work Phone ##: _________________

Mobile ##: _________________ E-mail Address: ____________________________________________________

Applicant's Drivers License ##: ____________________________________ State Issued: ______

Applicant's Present Employer: _________________________________________ Monthly Income: __________

Position/Department: _____________________________ From: __________ (mm/yy) To: __________ (mm/yy)

Supervisor's Name: ____________________________________ Supervisor's Phone ##: _________________ *Please provide check stubs for verification

Applicant's Previous Employer: _________________________________________ Monthly Income: __________

Position/Department: _____________________________ From: __________ (mm/yy) To: __________ (mm/yy)

Supervisor's Name: ____________________________________ Supervisor's Phone ##: _________________

ADDITIONAL INCOME

Source: ____________________________________________ Amount: _________ Duration: _________ months

In emergency, please notify: _________________________________________ Phone ##: _________________

Make of Car Model Year License Plate

Names, Ages & Relationships of Occupants Living in the home: Name Age Relationship

Describe in detail the weight, name, breed, and age of ANY pet that will be living in the home - This application must be signed by all adults who will occupy the apartment/home before it can be considered by the Owner or his Agent. Acceptance of this application, and any monies deposited herewith, is not binding upon the Owner or his Agent until approved by the Owner or his Agent in writing. If approved, all monies deposited within the application will be held as a reservation deposit to be either returned to applicant or credited toward the deposit which is required of the applicant at the time the rental agreement is executed. If applicant withdraws the application within 3 days, the Agent will require a cancellation fee of $150. If the withdraw occurs after the 3day period all of the deposit received will be forfeited by the applicant. A non-refundable screening fee of $35.00 per applicant will be collected to process this application. By signing, the applicant recognizes that an investigative report will be prepared whereby information is obtained through interviews. This inquiry includes information as to your character, general reputation, credit and mode of living. This application may be rejected as a result of: any misrepresentations or insufficient information as a result of an incomplete application. You have the right to make a written request within a reasonable period of time to receive additional information about the nature and scope of this investigation. APPLICANT #1 SIGNATURE:____________________________________ DATE:____________________ APPLICANT #2 SIGNATURE:____________________________________ DATE:____________________