Residential Lease Application Form Page 4
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4AUTHORIZATION TO RELEASE INFORMATION
RELATED TO A RESIDENTIAL LEASE APPLICANT
I,
(Applicant), have submitted an application
to lease a property located at
(address, city, state, zip).
The landlord, broker, or landlord’s representative is:
(name)
(address)
(city, state, zip)
(phone)
(fax)
(e-mail)
I give my permission:
(1) to my current and former employers to release any information about my employment history and
income history to the above-named person;
(2) to my current and former landlords to release any information about my rental history to the above-
named person;
(3) to my current and former mortgage lenders on property that I own or have owned to release any
information about my mortgage payment history to the above-named person;
(4) to my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to
the above-named person; and
(5) to the above-named person to obtain a copy of my consumer report (credit report) from any consumer
reporting agency and to obtain background information about me.
Applicant’s Signature
Date
Note: Any broker gathering information about an applicant acts under specific instructions to verify some or all
of the information described in this authorization. The broker maintains a privacy policy which is available upon
request.
(TAR-2003) 10-16-07
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