Rental Application

Application fee $55.00 per applicant. All persons over the age of 18 must fill out a Rental Application. Applicant must provide
current, valid ID and proof of income. Application fees are non-refundable. Application fees can be paid by money order or
cashier’s check.

The undersigned hereby makes application to rent the premises located at

beginning on

at a monthly rental rate of $

PLEASE TELL US ABOUT YOURSELF

Name

First Name

Last Name

Phone

Date of Birth

Social Security No:

Name of Co-Applicant:

First Name

Last Name

Phone

Date of Birth

Social Security No:

Number of Dependents

List names of all other occupants who will live in the residence:

Pets:

PLEASE GIVE US YOUR RESIDENCE HISTORY FOR THE PAST THREE YEARS

BEGIN WITH MOST CURRENT

CURRENT ADDRESS

Month & year moved in

Reason for leaving

Owner or agent

Phone

Monthly rent amount

Fax #

PREVIOUS ADDRESS (if within 3 years)

Month & year moved in

Reason for leaving

Owner or agent

Phone

Monthly rent amount

Fax #

PLEASE GIVE US YOUR EMPLOYMENT INFORMATION FOR THE PAST THREE YEARS

CURRENT EMPLOYER:

Date Employed:

Employed As:

Supervisor:

Phone Number:

Company Address:

Salary: $

per

Please provide copy of W-2 or most current pay stub to support

CO-APPLICANT EMPLOYER:

Date Employed:

Employed As:

Supervisor:

Phone Number:

Company Address:

Salary: $

per

Please provide copy of W-2 or most current pay stub to support

If there are other sources of income you would like us to consider, please list income, source and person/company who we could contact for
confirmation. All applicants, 18 years and older, must provide picture identification and proof of income for this application to be considered.

PLEASE LIST YOUR BANK AND CREDIT REFERENCES

Bank

City/State

Branch

Type of Account

Bank

City/State

Branch

Type of Account

Bank

City/State

Branch

Type of Account

References

Driver’s License Number

State

Vehicle Make/Model

Year

Tag Number

State

Vehicle Make/Model

Year

Tag Number

State

Other Vehicles

EMERGENCY CONTACT Name

First Name

Last Name

Phone Number

Have you or any proposed occupant ever:

Filed for bankruptcy?

Yes

If Yes, when was a discharge granted?

Been evicted from any tenancy?

Yes

Willfully or intentionally refused to pay rent when due?

Option 2

Do you have any pending judgments or legal proceedings pending against you?

Yes

If Yes, explain

Been convicted of a Felony?

Option 2

Been convicted of any crime involving the use, possession, distribution or intent to distribute a controlled substance?

Option 2

Please give any additional information that might help management evaluate this application:

If management has any questions about this application, please give PHONE NUMBERS where you can be reached:

DAY PHONE:

EVENING PHONE:

I hereby apply to lease the above-described premises for the term and upon the conditions above set forth and agree that the rent is to
be payable on the 1st day of each month in advance. As an inducement to the owner of the property and to the agent to accept this
application, I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation
or not a true statement of facts all earnest money will be retained to offset the agent’s cost, time, and effort in processing my
application. Once an application is approved, security deposit must be paid to place the property on hold for up to thirty days. If the
prospect cancels, security deposit(s) are not refundable.

I RECOGNIZE THAT AS PART OF YOUR PROCEDURE FOR PROCESSING MY APPLICATION, AN INVESTIGATIVE CONSUMER
REPORT AND/OR A CRIMINAL BACKGROUND CHECK MAY BE OBTAINED. IN ADDITION, EMPLOYMENT VERIFICATION AND
RESIDENCY VERIFICATION WILL BE REQUESTED. I HEREBY AUTHORIZE C. B. MANAGEMENT SERVICES, INC. TO MAKE
SUCH INQUIRES AND THIS SHALL SERVE AS AUTHORIZATION TO ALL NECESSARY PARTIES TO RELEASE THE
REQUESTED INFORMATION.

The above information, to the best of my knowledge, is true and correct. This Application, upon execution of a Lease Agreement shall
be incorporated into the Lease and made a part thereof.

Signature of Applicant

Date Signed

Signature of Co-Applicant

Date Signed

WE ARE AN EQUAL OPPORTUNITY HOUSING PROVIDER AND DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, GENDER,
DISABILITY, NATIONAL ORIGIN, RELIGION OR FAMILIAL STATUS.

DEPOSIT OF $

RECEIVED BY (NAME)

Date

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