Rental Application

Equal Housing Opportunity

What property you applying for? *

Full Name *

Phone *

Email *

Social Security Number *

Other Phone

Emergency Contact #1

Emergency Contact #2

Emergency Contact #3

Co-Applicant Name

Co-Applicant Phone Number

Co-Applicant Email

Co-Applicant Social Security Number

Co-Applicant Other Phone

Co-Applicant Emergency Contact #1

Co-Applicant Emergency Contact #2

Co-Applicant Emergency Contact #3

List of All Pets

Do you or does anyone living with you smoke? *

Yes

Names of all occupants and ages:

Do you have a Housing Voucher? *

Yes

Please Give Residential History

(Last 3 Years)

Current Address

Current Address *

Unit#

City *

State *

Zip *

Month/Year Moved In *

Moved Out *

Reason for Leaving *

Rent *

Owner/Agent *

Phone *

Previous Address 1

Previous Address 1 *

Unit# *

City *

State *

Zip *

Month/Year Moved In *

Month/Year Moved Out *

Reason for Leaving *

Rent *

Owner/Agent *

Phone *

Previous Address 2

Previous Address 2 *

Unit# *

City *

State *

Zip *

Month/Year Moved In *

Month/Year Moved Out *

Reason for Leaving *

Rent *

Owner/Agent *

Phone *

Please Describe Your Credit History

Have you declared bankruptcy in the past seven (7) years? *

Yes

Have you ever been evicted from a rental residence? *

Yes

Have you had two or more late rental payments in the past year? *

Yes

Have you ever willfully or intentionally refused to pay rent when due? *

Yes

We will be running a third-party credit check and criminal background check. If there will be any negative items on these or from the questions above, please take this chance to explain the situation. Remember, we understand if you do have issues and it does not disqualify you from renting.

Please Provide Your Employment Information

Status *

Full Time

Part Time

Student

Unemployed

Employer *

Dates Employed *

Employed As *

Supervisor Name *

Phone *

Salary per month *

Most Recent Pay Stubs (1 month) *

(If employed by above less than 12 months, give name & phone of previous employer or school:

If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

Amount per month

Source/Contact Name

Co- Applicants Employment Information:

Status

Full Time

Part Time

Student

Unemployed

Employer

Dates Employed

Employed As

Supervisor Name

Phone

Salary per month

(If employed by above less than 12 months, give name & phone of previous employer or school:

Amount per month

Source/Contact Name

Additional Information:

Banking Institution *

Checking or savings *

List all past issues with your former residence so we can be sure these issues do not reoccur

Where may we reach you to discuss this application?

Day Phone Number *

Night Phone Number

I hereby apply to lease the above-described premises (the “Premises”) for the term and upon the conditions set forth in this application, and I acknowledge and agree that rent is payable the first day of each month, in advance. As an inducement to the owner of the property (“Owner”) and to DPA Management as the leasing agent (“Agent”), to accept this application, I represent andwarrant that all statements made in this application are true and correct; however, should any statement made in this application be untrue, incorrect or a misrepresentation of fact(s), I agree that my application will be denied and my Application Fee (defined below) will be retained by Agent to offset the agent's cost, time, and effort in processing my application.

I hereby deliver to Agent, $45 as an application fee (“Application Fee”) in connection with my application to lease the Premises. Except as otherwise provided in this application, the Application Fee will be refunded to me if this application is not accepted by Owner within three (3) business days. Upon acceptance, the Application Fee shall be retained as part payment of the security deposit due under the lease for the Premises. If my application is so approved and accepted, within three (3) business days, I agree to execute a lease for the Premises for a term of 12 months before possession is given, using Owner’s standardlease form. To the maximum extent permitted by law, if my application is not approved or accepted by Owner, I hereby waive any claim for damages by reason of non-acceptance of my application. If I withdraw my application for any reason, I agree that the Application Fee will be retained by Agent to offset Agent's cost, time, and effort in processing my application. Additionally, if I fail to execute a lease for the Premises using Owner’s standard lease form, within three (3) business days after acceptance of this application, I agree that the Application Fee will be retained by Agent to offset Agent's cost, time, and effort in processing my application. I agree to pay the full amount of the non-refundable move-in fee prior to possession and keys to the above described premises (“The Premises”).

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 others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.

Please sign: *

Clear

Applicant

Signing Date *

Please sign:

Clear

Co-Applicant

Signing Date

Authorization

Release of Information

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner/manager.

Please sign: *

Clear

Applicant Signature

Signing Date *

Please sign:

Clear

Co-Applicant Signature

Signing Date

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