PERSONAL DATA: APPLICATION TO RENT

TENANT'S PERSONAL AND CREDIT INFORMATION

MUST BE FILLED OUT COMPLETELY TO BE PROCESSED

NAME____________________________________  BIRTHDATE_______________   SOCIAL SECURITY#   ____________________

                                                                                                                                                    DRIVERS LIC.#  __________________    

NAME OF CO-TENANT______________________  BIRTHDATE_______________  SOCIAL SECURITY#    ____________________

                                                                                                                                                    DRIVERS LIC.#   __________________

MAIDEN NAME OR ALIAS/ IF DIVORCED, PREVIOUS NAME _________________________________________________________

PRESENT ADDRESS______________________________________________________ZIP__________ PHONE# _______________

HOW LONG AT PRESENT ADDRESS_________ REASON FOR MOVING________________________CURRENT RENT: $_______

CURRENT LANDLORD NAME ______________________________________________________PHONE#_____________________

PREVIOUS ADDRESS________________________________________________ZIP__________ PREVIOUS RENT:$____________

PREVIOUS LANDLORD NAME________________________________PREVIOUS LANDLORD PHONE#_______________________

NUMBER OF OCCUPANTS  _______  RELATIONSHIPS TO SELF______________________________________________________

NUMBER OF OCCUPANTS WHO SMOKE_________                   AGES__________________________________________________

LIST ANY PETS___________________________________________________________________NUMBER OF VEHICLES_______                                                                             CAR MAKE__________ YEAR________ MODEL___________ COLOR_______LIC.PLATE#____________

CAR MAKE__________ YEAR________ MODEL___________ COLOR_______LIC.PLATE#____________

OCCUPATION:     PRESENT OCCUPATION     PRIOR OCCUPATION       CO-TENANT'S OCCUPATION

EMPLOYER

_____________________________________________________________________________________________________________________

SELF-EMPLOYED, D.B.A.

_____________________________________________________________________________________________________________________

BUSINESS ADDRESS

_____________________________________________________________________________________________________________________

PHONE

_____________________________________________________________________________________________________________________

POSITION HELD

_____________________________________________________________________________________________________________________

HOW LONG

_____________________________________________________________________________________________________________________

NAME AND TITLE OF SUPERIOR

_____________________________________________________________________________________________________________________

TYPE OF BUSINESS

_____________________________________________________________________________________________________________________

MONTHLY GROSS INCOME

______________________________________________________________________________

ADDRESS OF PREMISES OFFERED FOR RENT_____________________________________________________________________________

I understand and agree that security, 1^st month’s rent and broker’s fees must be posted prior to the execution of a lease agreement in certified funds, money order or cash.

MONTHLY RENT: _____________.   SECURITY: _____________.  LAST MONTH _____________. BROKERS FEE  _____________.

I hereby deposit the sum of $_________ with the landlord/agent to secure the above premises to rent, pending execution of a lease agreement. I understand that my deposit may be applied toward any rent loss or other expenses the landlord/agent may incur as a result of my failure to fulfill my promise to rent the above named premises by signing a lease agreement no later than _________  and

to occupy by _________. Lease term: _________.

Landlord/agent agrees that the deposit is refundable if the above applicant is not approved, providing that this application has been filled out completely and truthfully.

Have you owned your own home in the past?  ___________. If yes, how long? _________. How many? _________.

Have you ever filed a petition for bankruptcy?   ___________________ if yes, when?______________.

Have you ever been evicted from any tenancy?                ___________________ if yes, when?______________.

Have you ever willfully and intentionally refused to pay rent when due? ___________________.

I hereby authorize landlord/agent to verify the validity of all the above information, and to inquire now or periodically with my employers, financial institutions, and any of the credit reporting bureaus available to him. I agree to supply any additional information needed by owner/agent to process this application and I acknowledge that my deposit will be forfeit if I do not comply with any such request.

I AGREE THAT MY SCREENING FEE OF _$25.00 per adult applicant_ IS NON-REFUNDABLE.

I hereby acknowledge receipt of a copy of this application agreement. I agree that landlord may terminate any agreement entered into in reliance on any misstatement made above. I declare, under penalty of perjury, all of the above information to be true and correct, to the best of my knowledge.

        •               APPLICANT_______________________________________________  DATE_________________________

        •               APPLICANT_______________________________________________  DATE_________________________

ATTENTION RENTAL AGENTS: SECURE YOUR TRANSACTION!   Before submitting, be sure you have:    

1. Full required deposit in cash, check or money order made out to the owner or “cash.”    2.  Required screening fee.    3. Application completed in full.

Please note: Keys will not be given unless funds are paid in full and/or checks have cleared.