Name (full name): ________________________________________________________

Social Security Number: __ __ __ - __ __ - __ __ __ __ DOB: ____ / ____ / ____

Home Phone: _______________________ Work Phone: _______________________

Cell Phone: _______________________ Email: _______________________

Driver's License / ID Number: _________________________ State: ____________

NUMBER OF OCCUPANTS _____________

NAME Relationship Birthdate 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? (Check one) ___ 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: Begin ______________ End ______________________

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: Indicate # or level of interest:

Bedrooms___ Baths____ Sq ft_____ Yard_____ Garage_____ Levels_____ Location:_________________

House_____ Condo_____ Duplex_____ Apt_____ 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

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THIS SECTION FOR INTERNAL USE ONLY Owner/Manager:___________

Property Address: ________________________City: _______, State: ____ Zip: ______

Lease starts __________________, 20___ to last day of __________________. 20___

If lease purchase, Date of Close: ________________ Sale Price: $________________

First Month's Rent: $________________ Security Deposit/Down Payment: $__________

Pet Fee: $________________ Pet Agreement Signed: _____

Application Fee: $_$50.00__________ LA Fee: $_______ REF Fee: $_______

TOTAL: $_________________ Buyer’s Agent: ________ Commission: _________

Rep: ________ Accepted______ Declined______ Date Letter Mailed: ___________