Rental Application - Pohlig Box Factory Page 3
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3EMERGENCY CONTACT
(
)
WHOM MAY WE CONTACT IN CASE OF PERSONAL EMERGENCY
SOMEONE NOT LIVING WITH YOU
________________________________________________________ __________________________________
LAST FIRST MIDDLE INITIAL
RELATIONSHIP
___________________________________________________________________________________________
&
NUMBER
STREET NAME
CITY
STATE
ZIP
___________________________________________ ________________________________________________
HOME PHONE NUMBER
WORK PHONE NUMBER
A
?
N
Y
I
,
______________
________
__________
RE YOU A PET OWNER
O
ES
F SO
WHAT KIND _
WEIGHT
AGE
CANCELLATION POLICY
Cancellation must be provided in writing prior to applicant receiving deposit. Applicant(s) has 48 hours to cancel application
following notification of approval for an apartment.
ALL RESERVATION/APPLICATION FEES ARE NON-REFUNDABLE
RESIDENT STATEMENT
I/We understand that the above information is being collected to determine my/our eligibility for residency. I/we authorize
the owner/management to verify all necessary information provided on this application, and my/our signature is consent to
obtain such verifications. I/WE FURTHER CERTIFY THAT THE FOREGOING INFORMATION IS TRUE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
“I hereby authorize Pohlig Box Factory LLC to obtain a consumer report, and any other
information it deems necessary, for the purpose of evaluating my rental application. I
understand that such information may include, but is not limited to, credit history, civil and
criminal information, records of arrest, rental history, employment/salary details, vehicle
records, licensing records, and/or any other necessary information. I hereby expressly
release Pohlig Box Factory LLC, and any procurer or furnisher of information, from
any liability what-so-ever in the use, procurement, or furnishing of such information,
and understand that my application information may be provided to various local,
state and/or federal government agencies, including without limitation, various law
enforcement agencies.”
SIGNATURE OF ALL ADULTS TO APPEAR ON LEASE
___________________________________________ ___________________________________________________
SIGNATURE OF APPLICANT
SIGNATURE OF APPLICANT
___________________________________________ ___________________________________________________
DAYTIME CONTACT NUMBER
DAYTIME CONTACT NUMBER
___________________________________________ ___________________________________________________
EMAIL ADDRESSS
EMAIL ADDRESS
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