Rental & Credit Application

$50 Application fee due when submitted - FEE IS NON-REFUNDABLE

Date:

Taken by:

Payment Method:

Personal Information

First Name:

Middle:

Last Name:

Phone:

Cell Phone:

E-Mail:

Driver's License #:

Issuing State:

Social Security:

Birth Date:

Present Street Address:

Address:

City:

State:

Zip:

Name of Landlord:

Telephone:

How Long have you lived at this address?

Years:

Months:

Prior Address:

Address:

City:

State:

Zip:

Name of Landlord:

Telephone #:

How Long have you lived at this address?

Years:

Months:

How many will be living in this unit?

Number of Adults:

Number of Children:

Children Name & Ages:

Number of Pets:

Breed:

Weight of Pets:

Current Employer

Current Employer:

Occupation:

Business Phone:

Annual Income:

Contact Person:

Telephone #:

How Long employed at present position?

Years

Months

Emergency Information (Outside household)

Name:

Relationship:

Contact Number:

Spouse Information

First Name:

Middle:

Last Name:

Phone:

Cell Phone:

E-Mail:

Driver's License #:

Issuing State:

Social Security:

Birth Date:

Spouse Current Employer

Current Employer:

Occupation:

Business Phone:

Annual Income:

Contact Person:

Telephone:

How Long employed at present position?

Years

Months

Personal/Credit References

Name:

Relationship:

Telephone:

Name:

Relationship:

Telephone:

Name:

Relationship:

Telephone:

Other Information

Vehicle - 1

Make/Model:

Color:

Tag:

Year:

State:

Vehicle - 2 (if applicable)

Make/Model:

Color:

Tag:

Year:

State:

Vehicle - 3 (if applicable)

Make/Model:

Color:

Tag:

Year:

State:

Have You Ever:

Filed for Bankruptcy?

Yes No

If so, when?:

Been served an eviction notice or been asked to vacate a property you were renting?

Yes No

Willfully or intentionally refused to pay rent when due?

Yes No

Been sued or unlawful detainer?

Yes No

Currently on "Active" Military status?

Yes No

How were you referred to us?

Realtor (Name):

Newspaper (Name):

Friend:

Internet:

Other:

Acknowledgement

I/We, undersigned, understand that Starheel Properties, Inc. is the leasing agent and representative for theowner/landlord and that the leasing agent's fees will be paid by the owner/landlord. The undersignedacknowledge that this written notice was received prior to the undersigned receiving a lease agreement.

Applicant Signature:

Date:

Co-Applicant Signature:

Date:

Consent to obtain credit/employment information

I/We authorize Starheel Properties, Inc. to investigate my/our credit qualifications and hereby release, in anymanner, all of the information obtained by you. I/We further release all persons, agencies, or firms from any liabilities resulting from providing such information.

The undersigned authorizes landlord, leasing agent, and representatives of owner/landlord to contact theundersigned's current or previous landlord, and current employer, and further, by a copy of this Application,authorizes any said landlord or employer to release pertinent residential and employment history information to be used in evaluating my lease application. I further authorize owner/landlord, leasing agent or its representatives to apply for or obtain an investigation or credit report in connections with this application.I understand that said investigation or credit report may contain information obtained from various stategovernmental and private entities relative to the undersigned's number of children, employment, occupation,general health, financial, and criminal history information.

I/We declare under penalty of perjury that the information listed in this application is true and correct.

Applicant Signature:

Date:

Co-Applicant Signature:

Date: