Application To Rent
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3OREGON WEST MANAGEMENT, LLC
th
350 S 8
St. | Coos Bay, OR 97420
APPLICATION TO RENT
Ph: 541-269-1912 | Fax: 541-267-6201
Email:
Owner/Agent to Complete
Property Address:
Move-in Date: _________________
Monthly Rent: $
Security Deposit: $
(Security Deposit may increase depending on screening and other factors)
Unit Type Desired:______________ No. of Units Available: __________ Applicant No.________ Date: _____________ Time:__________
am
pm
Examined picture identification?
Yes
No
Type of identification__________________________________
EACH APPLICANT AND CO-APPLICANT OVER AGE 18, AND GUARANTOR (CO-SIGNER) MUST SUBMIT A SEPARATE APPLICATION.
Directions for Completing and Submitting the Form: Complete the Application, sign and date on the bottom of page 2 - Submit Pg 1
& 2 by fax, mail, email or deliver to [contact info above] . If faxed, mailed or emailed, you will be contacted with confirmation of receipt
and directions on sending payment for screening charges. Apartments subject to availability.
Check one:
APPLICANT
CO-APPLICANT
GUARANTOR (CO-SIGNER)
(Please print or type)
Name:
First Name
Middle
Last
Other Names Used in Last 10 Years:
Work Ph: (
)
Home Ph: (
)
Cell Ph: (
)
Email:
Social Security or ITIN #
Date of Birth:
Drivers License # and State:
Current Address:
Street address
City, State, Zip
County
Moved in:
Landlord:
Ph: (
)
Fax: (
)
Rent Amount: $
Why are you moving?
Previous Address:
Street address
City, State, Zip
County
From:
To:
Landlord:
Ph: (
)
Fax: (
)
Rent Amount: $
Why did you move?
Previous Address:
Street address
City, State, Zip
County
From:
To:
Landlord:
Ph: (
)
Fax: (
)
Rent Amount: $
Why did you move?
Have you ever:
Been Evicted?
Yes
No
Been sued by Landlord?
Yes
No
Filed Bankruptcy?
Yes
No
Been convicted, plead guilty, or no contest, to a crime in the last 5 years? Yes
No
If Yes to any of these, please explain:
EMPLOYMENT AND INCOME
Current Employer:
How Long?
Your Job Title:
Monthly take home pay: $
Full-time
Part-time
Contact for employment verification:
Ph: (
)
Fax: (
)
Previous Employer:
How Long?
Your Job Title:
Monthly take home pay: $
Full-time
Part-time
Contact for employment verification:
Ph: (
)
Fax: (
)
Disclose additional income if to be included for qualification hereunder
Other Income (per month): $
Source:
Other Income (per month): $
Source:
Equal Housing Opportunity
Rev 7/14
Page | 1
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