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. You may also download a
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.
NOTE: Please CLICK the Calender image to select all DATES. Otherwise, enter the DATE in the following format:
MM / DD / YYYY (Example:
12 / 25 / 2008 )
. Failure to do this could result in errors in submitting your application.
Online Lease Application
APPLICANT INFORMATION
* Name (Full Name):
(*) Indicates Required Field
* Date of Birth:
Home Phone:
Work Phone:
Cell Phone:
* E-mail Address:
Driver's License/ID Number:
State:
NUMBER OF OCCUPANTS
Name
Relationship
Date of Birth
Work or School Phone
1
2
3
4
APPLICANT EMPLOYMENT HISTORY
Current Employer
Name and Address:
Phone:
Fax:
Income:
$
Position:
Supervisor:
Length of Employment:
Still Employed?:
Yes
No
Previous Employer (if you have changed jobs in the last 2 years)
Name and Address:
Phone:
Fax:
Income:
$
Position:
Supervisor:
Length of Employment
From:
To:
RENTAL HISTORY
* Current Address:
Dates Lived at This Address:
* From:
* To:
Reason for Leaving:
Landlord/Manager:
Phone:
Fax:
Previous Address:
Dates Lived at This Address:
From:
To:
Reason for Leaving:
Landlord/Manager:
Phone:
Fax:
Other Income:
$
Source:
Bank and Financial Accounts-Checking Institution Name:
Car #1 Model/Year/color:
License Plate #:
State:
Car #2 Model/Year/color:
License Plate #:
State:
MISCELLANEOUS: (check appropriate answer)
Do you have Pets?:
Yes
No
If so, describe:
Do you Smoke?:
Yes
No
Do you plan to have water filled furniture on the rental property?:
Yes
No
If yes, explain:
Have you ever been Evicted?:
Yes
No
If yes, explain:
Have you ever been Convicted of a Felony?:
Yes
No
If yes, explain:
Have you ever filed for bankruptcy?:
Yes
No
If yes, Date:
Discharged?:
Anything you wish to explain?:
APPLICANT PERSONAL/EMERGENCY REFERENCES
* Name:
*Relationship:
* Address:
Phone:
Known this reference how long?:
Name:
Relationship:
Address
Phone:
Known this reference how long?:
What are you looking for in your next home?
* Bedrooms:
::Please Select::
1
2
3
4
5
6
*Bathrooms:
::Please Select::
1
2
3
4
5
6
Square Footage:
Yard:
Garage:
Levels/Floors:
Property Type:
House
Apartment
Condominium
Duplex
Age/Type of Property:
School Preference:
Elementary
Middle
High
Describe the most important feature or convenience:
*Move-in Date Desired:
Dates available to view homes:
*Rent Range Desired
*Length of lease:
Lease/Purchase Option?:
Questions we can assist you with:
*How did you hear about us:
Applicant authorizes the owner/agent to contact past and present landlords, employers, creditors, credit bureau, neighbors and any other sources deemed necessary to investigate applicant. All the information is true, accurate and complete to the best of applicant's knowledge. Owner/Agency reserves the right to disqualify tenant if information is not as represented. ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME
I acknowledge that I have received the Agency Disclosure brochure and I have elected to be a customer or a client. As a client I have signed an agency agreement to be represented by an agency affiliated with National Real Estate Services. As a customer I understand I have no representation in this transaction.
*APPLICANT SIGNATURE
*DATE