1st Applicant's
Name * |
|
E-mail* |
|
Maiden Name |
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Social Security No. * |
|
Date of Birth * |
|
Drivers Licence No.* |
|
State* |
|
|
2nd Applicant's
Name |
|
Maiden Name |
|
Social Security No. |
|
Date of Birth |
|
Drivers Licence No. |
|
State |
|
PRESENT RESIDENCE INFORMATION |
Present Address * |
|
City * |
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State* |
|
Zip* |
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Telephone* |
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Is this your telephone?* |
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How long at this address?* |
|
Landlord's name * |
|
Landlord's address * |
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Landlord's telephone * |
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What month & year did you move in? * |
|
|
What name is used by gas & electric company for billing? * |
|
What name is used by the
phone company for billing? * |
|
What name is used for water company for billing? * |
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Where do you pay your rent? *(address/city/state/zip) |
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Why are you moving? * |
|
How much is your current rent? * |
|
Previous Address * |
|
City * |
|
State* |
|
Zip* |
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Previous Landlord * |
|
Previous Landlord's Phone * |
|
EMPLOYMENT REFERENCES
|
1st Applicant's Employer * |
|
Employer's Address * |
|
Employer's Phone No.* |
|
Supervisor's Name |
|
Department* |
|
Phone No. * |
|
Length of time employed * |
|
Position* |
|
Monthly income * |
|
Any additional
income
*
|
|
2nd Applicant's Employer |
|
Employer's Address |
|
Employer's Phone No. |
|
Supervisor's Name |
|
Department |
|
Phone No. |
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Length of time employed |
|
Position |
|
Monthly income |
|
Any additional income |
|
BANKING REFERENCES
|
Bank Name (Checking/Acct.)* |
|
Account No. * |
|
Bank Name (Checking/Acct.) |
|
Account No. |
|
Bank Name (Saving/Acct.) |
|
Account No. |
|
NAMES OF PEOPLE WHO WILL BE LIVING AT THIS
ADDRESS |
Name |
|
Relationship |
|
Name |
|
Relationship |
|
Name |
|
Relationship |
|
Name |
|
Relationship |
|
Name |
|
Relationship |
|
PERSONAL REFERENCES (NOT RELATED) |
Name * |
|
Address * |
|
Phone * |
|
Name * |
|
Address * |
|
Phone * |
|
Name * |
|
Address * |
|
Phone * |
|
Mother's name * |
|
Mother's address * |
|
Father's name * |
|
Father's address * |
|
IN CASE OF EMERGENCY CONTACT
|
Name * |
|
Phone * |
|
Address * |
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Relationship * |
|
Name |
|
Phone |
|
Address |
|
Relationship |
|
VEHICLES OWNED
|
Auto Lic. Plate No. |
|
Make |
|
State |
|
Year |
|
Auto Lic. Plate No. |
|
Make |
|
State |
|
Year |
|
Auto Lic. Plate No. |
|
Make |
|
State |
|
Year |
|
|
Have you ever been
convicted of a: * |
|
If yes, explain |
|
Have you ever gone through bankruptcy, been evicted,
had any judgements, creditors or other legal proceeding against you?
*
|
Yes |
|
No |
|
If yes, explain |
|
Property address of
residence you are applying to rent * |
|
|
|
A non-refundable credit checking fee of $25.00 for 1st applicant and $15 for each additional is due at the time the rental application is processed. |
|
I/we hereby authorize POMERANCE PROPERTIES, LP and/or any Credit Information Services to obtain information concerning my past credit, and/or tenant-landlord history now or anytime in the future. I hereby authorize any of the following sources, including but not limited to landlords, public or privately owned utilities, current or past creditors, governmental housing agencies, and/or other credit reporting agencies to release any information to POMERANCE PROPERTIES, LP or any Credit Information Service concerning my/our past credit and/or tenant-landlord history. I hereby release any of the above sources, their officers, agents, or employees from any liability for damages of whatsoever kind or nature whether caused by negligence or otherwise which may at any time result to me/us by reason of compliance with the above mentioned inquiry which may include the answering of specific questions and the giving of any information concerning my/our past records. |
|
I HAVE READ THE ABOVE AND I AM IN COMPLETE AGREEMENT WITH IT. |
1st applicant name * |
|
2nd applicant name |
|
Date * |
|
|
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