Fillable Nebraska Rental Application (Page 2 of 2) in pdf

APPLICANT NAME

MISCELANEOUS INFORMATION

TOTAL NUMBER OF VEHICLES (Including Company Vehicles)

Make/Model

Year

Color

TagNo./State

Make/Model

Year

Color

TagNo./State

IN CASE OF PERS

ONAL EMERGENCY, NOTIFY:

Relationship:

Full Address:

Home Phone:

Cell Phone

Work Phone

NOTE: Applicant understands that by signing this application, applicant authorizes Management to remove this rental unit

from the rental market. Applicant is legally obligated for the rental unit, and will be held responsible accordingly. IF I

SHOULD CANCEL THE APPLICATION, THE ENTIRE DEPOSIT WILL BE RETAINED AS TERMINATION CHARGES.

APPLICANT WILL BE RESPONSIBLE FOR RENT FROM DATE OF MOVE-IN OR UNTIL UNIT HAS NEW RESIDENT

RESIDING IN IT, WHICHEVER COMES FIRST. All cancellations must be in writing. If the applicant is declined, the deposit

may be refunded. This application must be filled out COMPLETLEY AND ACCURATELY. I understand that in the event a

lease is entered into, it may be canceled by the landlord if any of the information provided in the application is materially

inaccurate or incomplete. Management reserves the right to cancel this application if application is unable to have utilities

placed in their name.

By signing this application, I authorize the Landlord or Landlords’ agents to verify above information such as employment,

monthly income, and past residential history. Verification or re-verification of any information contained in the application will

be retained by the landlord. Any person or entity identified on this application or holder of public record is hereby instructed to

release information regarding the application, my credit, tenant, check writing histories and or my criminal record to

MANAGEMENT. Agencies used by MANAGEMENT to acquire this information may include, but are not limited to, Experian

(TRW) Credit Services, Equifax/Capital CSC Credit Services, TeleCheck, and/or any law enforcement agency. Upon request,

HIP/ Holroyd Investment Properties will provide the name and phone number of any outside agency used in the verification

process.

When a Co-Signer is required, the Co-Signer Application must be filled out completely, signed and delivered to our office

within 48 hours of being informed. If the Co-Signer Application is not received within a 48 hour period, the subject unit applied

for may be put back on the market.

Resident acknowledges and consents that he/she understands that MANAGEMENT is the Common Law agent for the owner, and

as such resident is a customer, not a client of HIP/ Holroyd Investment Properties Inc.

Signature of Applicant

Date Signed

Signature of Employee

Date Signed

APPLICANT: PLEASE DO NOT WRITE BELOW

Application Fee Received: $

Pd. W/Ck. #

Security Deposit Received: $

Pd. W/Ck. #

Reference Verification Name

Reference Comments

Landlord:

Employer:

Credit Report:

Point Score:

Comments:

THIS APPLICATION

APPROVED

NOT APPROVED

Title

Date

If not approved, specify reason(s)

Applicant Notified by (Name)

Date Notified

Notified by:

LETTER (Attach Copy)

FORM

TELEPONE

FAX

IN PERSON

Nebraska Rental Application Page 2

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