Date _________________ Time___________________

APPLICATION TO RENT

Individual applications required from each adult occupant (All sections must be completed)

Last Name ___________________ First Name ___________________ Date of Birth _______________

Social Security # _______________ Driver’s License # _______________ State _____________________

Home Phone _______________ Work Phone _______________ Alternate Phone _______________

1.
Present Address _______________ City _______________ State _______________ Zip _______________
Date In: _______________ Date Out: _______________

Owner/Manager Name ______________________________ Phone _______________

Reason for Leaving____________________________________________________________________________________

2.
Previous Address _______________ City ____________________ State _________ Zip ___________
Date In: _________ Date Out:__________ Owner/Manager Name _____________________ Phone _______________

Reason for Leaving______________________________________________________________________________________

Name & Age of Other Occupants

1.
Present Occupation ___________________ Employer Name _____________________________________
How Long __________ Name of Supervisor _____________________________ Phone # _______________
Address ___________________ City _________________________ State _______ Zip ____________
Current Gross Income ______________________________

2.
Prior Occupation ___________________ Employer Name _____________________________________
How Long __________ Name of Supervisor _____________________________ Phone # _______________
Address ___________________ City _______________ State _______ Zip ____________

Name of Bank __________________________________
Address ______________________________________________
Checking # __________________________________________
Savings #________________________________________

List Financial Obligations:

Creditor Name Address Phone # Monthly Payment

In case of Emergency Contact: ___________________________ Phone #_________________________ Relationship________

Have you ever been arrested convicted/accused of a crime against persons or property, or drug/alcohol related crimes? _________

Filed a petition in Bankruptcy? _________ Have you ever been evicted?__________________

Do you smoke? _________ Do you have any pets?_______ If so what kind ____________________________________________

Applicant represents that all of the above statements are true and correct and hereby authorizes verification of the above items including but not
limited to the obtaining of credit reports and agrees to furnish additional credit references on request. Applicant also attests that all occupants of
the apartment/property will be legal to reside in the United States.

The undersigned makes application to rent housing accommodations designated as:_____________________________________________
The rental for which is $ __________ per month and upon approval of this application agrees to sign a rental or lease agreement and to pay all
sums due, including deposits, before occupancy.

An application fee of $ 20/per person over 18 is non-refundable.

DATED: ___________________ 20_____

Signed:_____________________________________________________________

All applications will be reviewed in the order received and judged based on the attached
rental criteria. Owner/Agent does not discriminate on the basis of race, color, religion,
gender, national origin, disability, familial status or source of income

PLEASE FAX COMPLETED APPLICATION TO 1-800-635-6592 OR

EMAIL IT TO MARKETSOURCERE@GMAIL.COM.

QUESTIONS CALL 800-811-1789 extension #2