Name *
Have you declared bankruptcy in the past seven (7) years? *
Have you ever been evicted from a rental residence? *
Have you had two or more late rental payments in the last year? *
Have you ever willfully or intentionally refused to pay rent when due? *
If not employed, do you receive:
Banking Accounts:
Personal Reference or Emergency Contact:
Additional Information:
I 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 made above set forth are true; however, should any statement made above be a misrepresntation 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. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with other with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.
I authorize an investigation of my credit, tenant history, banking and employment for the purpose of renting a house, apartment or condominium from this owner / manager.