Rental Property Applying For

Amount of Rent

Desired Move-In Date

One Year Lease

6 Month Lease

Month-To-Month

APPLICANT'S INFO

Full Name of Applicant

Social Security Number

Date of Birth

Driver's License Number

State Issued & Exp. Date

Home Phone Number

Work Phone Number

Cell Phone Number

E-mail Address

Current Residence Address

How Long At Current Address?

Reason For Leaving

Name of Landlord/Manager and Phone Number

May We Contact Your Current Landlord/Manager? Yes  No

Previous Residence Address

How Long At Previous Address?

Reason For Leaving

Name of Landlord/Manager and Phone Number

May We Contact Your Previous Landlord/Manager? Yes  No

OCCUPANTS/PETS

Name(s) of All Other Proposed Occupants and Relationship to Applicant

Proposed Pet(s), Number, Type, Breed, Age, Weight, Spayed/Neutered

EMPLOYMENT/INCOME

Current Employer

Dates of Employment

Position/Title

Gross Income

Per Hour Per Month Per Year

Current Supervisor's Name

Current Employer's Address, Phone Number & Website URL

Previous Employer

Dates of Employment

Position/Title

Gross Income

Per Hour Per Month Per Year

Previous Supervisor's Name

Previous Employer's Address, Phone Number & Website URL

Other Income & Source

AUTOS

1 - Make, Model, Year, Color, License No. and State Issued

2 - Make, Model, Year, Color, License No. and State Issued

3 - Make, Model, Year, Color, License No. and State Issued

4 - Make, Model, Year, Color, License No. and State Issued

BANKING INFORMATION

1 - Name of Bank or Financial Institution

1 - Address or Branch Location

1 - Account Number

Checking  Savings

2 - Name of Bank or Financial Institution

2 - Address or Branch Location

2 - Account Number

Checking  Savings

PROFESSIONAL REFERENCES

1 - Name, Address, Phone, Length of Acquaintance

2 - Name, Address, Phone, Length of Acquaintance

3 - Name, Address, Phone, Length of Acquaintance

EMERGENCY CONTACTS

1 - Name, Address, Phone Number and Relationship of Person To Notify

2 - Name, Address, Phone Number and Relationship of Person To Notify

3 - Name, Address, Phone Number and Relationship of Person To Notify

QUESTIONS

1. Does Applicant or Occupant(s) plan to use liquid-filled furniture?

Yes No

If the above answer is Yes, type of liquid-filled furniture:

2. Does Applicant or Occupant(s) smoke?

Yes  No

If the above answer is Yes, name:

3. Has Applicant or Occupant(s) been a party to an unlawful detainer action or filed bankruptcy within the last seven years?

Yes  No

If the above answer is Yes, please explain:

4. Has Applicant or Occupant(s) ever been convicted of, or pled nolo contendre to, a misdemeanor or felony (other than a traffic or parking violation)?

Yes  No

If the above answer is Yes, please explain:

5. Has Applicant or Occupant(s) been evicted from any tenancy or have had any eviction notice served?

Yes  No

If the above answer is Yes, please explain:

6. Has Applicant or Occupant(s) ever willfully and intentionally refused to pay any rent when due?

Yes  No

If the above answer is Yes, please explain:

7. Is Applicant or Occupant(s) a current illegal abuser of a controlled substance or have ever been convicted of the illegal manufacture or distribution of a controlled substance?

Yes  No

If the above answer is Yes, please explain:

8. If Applicant or Occupant(s) request any additional items to be provided, please check the box(es) below:

Refrigerator  Washer  Dryer  Gardener

1. Applicant represents the above information to be true and complete and hereby authorizes verification of the information provided and the obtaining of a credit report upon providing a completed Signature Affidavit, copies of Applicant’s driver’s license and social security card and non-refundable Rental Screening Fee of $30.00 to Leilani Souza. Applicant understands that he/she is entitled to a copy of any consumer credit report obtained by Leilani Souza and the request shall be made in writing.

I have read, understand and AGREE to the above terms.

I DO NOT AGREE to the above terms and my application WILL NOT be processed.

2. Applicant understands and agrees: (i) this is a Rental Application only and does not guarantee that Applicant will be offered the Premises; and (ii) Landlord/Manager/Agent may accept more than one Rental Application for the Premises and, using their sole discretion, will select the best-qualified Applicant. Applicant agrees that Leilani Souza may terminate any agreement entered into in reliance on any misrepresentations made above.

I have read, understand and AGREE to the above terms.

I DO NOT AGREE to the above terms and my application WILL NOT be processed.

3. I UNDERSTAND THAT IF I AM APPROVED FOR THE PREMISES AND AGREE TO SIGN A RENTAL AGREEMENT, I WILL SUBMIT A $500.00 GOOD FAITH DEPOSIT TO TAKE THE PROPERTY OFF THE MARKET, WHICH WILL BE APPLIED TO MY TOTAL MOVE-IN COSTS AND IS NON-REFUNDABLE IF I BREACH THE TERMS OF THE RENTAL AGREEMENT. I ALSO AGREE THAT THE REMAINING BALANCE OF MY MOVE-IN COSTS IS DUE AND PAYABLE UPON MOVE-IN AND SHALL BE MADE IN CERTIFIED FUNDS ONLY (E.G. CASHIERS’ CHECK).

I have read, understand and AGREE to the above terms.

I DO NOT AGREE to the above terms and my application WILL NOT be processed.

Type in your full name as your "eSignature"