Property Management Agency/subagency Disclosure Page 4
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4EMERGENCY CONTACT
In case of emergency, notify:
Relationship:
Address:
Phone:
Employment Information
Name of Current Employer/Company:
Address:
Supervisor:
Check One: Salary Hourly Self-Employed
Employment Income: $
Phone No. to Verify Salary:
How long with this employer?
Name of Prior Employer/Company:
Address:
Supervisor:
Check One: Salary Hourly Self-Employed
Prior Employment Income: $
Phone No. to Verify Salary:
How long with this employer?
Other Sources of Income
Source:
Amount $
How Often?
Source:
Amount $
How Often?
Financial Information
Name of your Bank:
Branch/Address:
Checking Account: Yes No
Savings Account: Yes No
List any real estate or auto loans:
Name of Creditor
Address
Phone
Mo. Pmt. Amount
This section for office use only.
Application received:
, 2____
By:
Processing fee paid:
, 2____
Amount
$
cash
check
money order
By:
Holding Deposit paid:
, 2____
Amount
$
cash
check
money order
Complete and attach Verification/Screening Form.
APPLICATION
ACCEPTED by:
or REJECTED by:
Date
Remarks:
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Parent category: Legal