Rental and Credit Report Application      SecurityInfo

  Full Name(s): _______________________________________  TodaysDate: ____ / ____ / ______

 Current Address: _________________________________________________________________

 Email Address:  _____________@________________________   Pets?: _____________________

 Telephone/Cell Phone#:_____________________________________  Do you smoke?:  Yes / No

 Birth Date: _____ / ____ / ______    Place of Birth: ______________________________________

 Social Security#: _____ - ____ - ______   Drivers License#: __________________ State: ______

 Ever been arrested?: Yes / No    Employer & address or rent source: ______________________

   _________________________________________________ Monthly Income: $_______________

Years with Company: __________  Supervisors Name & phone: ___________________________

 _____________________________________________________  Other Income?:$____________

Describe:_________________________________________________________________________

Bank & branch: ___________________________ Type of Accounts: _______________________

 Outstanding Debts: __________________________________ Children/dependents?:  Yes  /  No

 Vehicle Make and Year: _________________________ Vehicle License#: ___________________

 Nearest Relative/Emerg. Contact: _______________________________ Phone#: _____________

 Last two places of residence (with who & how to contact): (1)____________________________

  _________________________________________________________________________________

 (2)_______________________________________________________________________________

   ______________________________________________ Desired movin date: _________________
    I certify that the above information is true and correct.    If selected I agree to pay $15.00 for a
  credit report check and give my permission to run same.    Answer all questions fully please.
(No one is charged a $15 Credit Report fee unless seriously considered as a tenant)

   Signed: ________________________________  Print name: _______________________________

                  (Use back of this form for explanations.   All information entered will be verified for accuracy)

               --------------------------------------------------------------------------------------------------------------------------

OFFICE USE:    TOT_____/    AGE____/    MONINC_____/    MONDEB_____/   SX___/      SSstate________/
  »Landlord uses Nationwide Credit & Tenant Reporting Agency® to rate tenant residence performance«