Residential Application And Instructions Dalmon Property Page 4
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4DALMON PROPERTY MANAGEMENT, INC. (DPM)
RENTAL/LEASE APPLICATION POLICIES & APPLICATION Page 4 of 4
References
Housing (Five years’ worth – use separate paper if necessary.)
Current Address
From
To
Landlord / Agent
Phone
Address
Reason For Moving
Rent you are paying
Previous Address
From
To
Landlord / Agent
Phone
Reason For Moving
Rent amount you paid
Credit
Bank
Checking
Savings
Address
Account Numbers
Phone Number
Account Numbers
Personal References
Name
Address
Phone
E-mail address
1.
2.
Emergency Contact - Name
Relationship
Address
Phone
Have you ever filed a petition of bankruptcy?
Have you ever been evicted from any tenancy or had an eviction notice served on you?
Have you ever willfully and intentionally refused to pay any rent when due?
Have you ever been convicted of a misdemeanor or felony other that a traffic or parking violation?
Are you a current illegal abuser or addict of a controlled substance?
Have you ever been convicted of the illegal manufacture or distribution of a controlled substance?
If yes to any of the above, please indicate date/circumstances:
I certify, by my signature below, that I have read, understood and agree to the policies and guidelines laid out in
this Application, and that all information provided by me is true and accurate to the best of my knowledge.
Applicant Signature:
Date:
1202 Grant Ave., Suite A-1 Novato, CA 94945 Ph (415) 898-2370 Fax (415) 898-2371
REV 03/2016
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