Rental Application For Residents And Occupants Page 2
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3OTHER OCCUPANTS:
1. Name ___________________________________ Relationship __________________
Sex ________ DOB ______________ Social Security # ________________________
2. Name ___________________________________ Relationship __________________
Sex ________ DOB ______________ Social Security # ________________________
3. Name ___________________________________ Relationship __________________
Sex ________ DOB ______________ Social Security # ________________________
4. Name ___________________________________ Relationship __________________
Sex ________ DOB ______________ Social Security # ________________________
YOUR VEHICLES:
Make ______________________ Model ___________________ Color __________________
Year __________ License Plate # _______________________ State ___________________
Make ______________________ Model ___________________ Color __________________
Year __________ License Plate # _______________________ State ___________________
EMERGENCY CONTACT:
Name _________________________ Relationship _____________ Phone # _____________
If you die or are seriously ill, missing, or in a jail or penitentiary according to an affidavit of (check
one or more) _____ the above person, _____ your spouse, _____ your parent or child, we may allow
such person(s) to enter your dwelling to remove all contents, as well as your property in the mailbox,
storerooms, and common areas. If no box is checked, any of the above are authorized at our option. If
you are seriously ill or injured, you authorize us to call EMS or send for an ambulance at your
expense. We are not legally obligated to do so.
YOUR RENTAL/CRIMINAL HISTORY:
Have you, your spouse, or any occupant listed in the Application ever:
____ been evicted or asked to move out? _____ moved out of a dwelling before the end of the lease
term without the owner’s consent? _____ declared bankruptcy? ______ been sued for rent? _____
been sued for property damage? _____ been charged, detained, or arrested for a felony or sex crime
that was resolved by conviction, probation, deferred adjunction, court-ordered community
supervision or pretrial diversion? _____ been charged, detained, or arrested for a felony or sex
related crime that has not been resolved by dismissal or acquittal? Please indicate below the year,
location and type of each felony and sex crime other than those resolved by dismissal or acquittal.
We may need to discuss more facts before making a decision.
______________________________________________________________________________
______________________________________________________________________________
CONTEMPLATED LEASE CONTRACT INFORMATION
st
• Prorated rent for: 1
month;
• Monthly rental due date 1st; Late charges due if rent is not paid on or before the 3rd;
• Initial late charge $50.00; Daily late charge $10.00 beginning on the 10
th
;
Returned check charge $35.00;
• Animal violation charges: Initial $100;
• Utilities paid by owner (check all that apply)
___
___
___
Electricity
Gas
Water
___
_X_
___
Wastewater
Trash ___ Cable TV
Other (please list) _______________
• You will (check one)
___
___
not buy insurance
buy insurance (not required);
• Your move-out notice will terminate Lease Contract on the last day of month.
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