GCAAR Rental Application Form

RENTAL APPLICATION (For Use in Montgomery County, Maryland)

GCAAR #1204 MC - Rental Application (Previously form #1204) 6/2012

Applicant’s Name: and, if applicable, Co-Applicant’s Name:

Application is made to lease property located at for monthly rental of $ Security Deposit: $

Lease Term: Move-in Date: Move-out Date:

A deposit in the amount of $ (the “Deposit”) is to be held by Landlord/Agent with the clear understanding that this Application, including each prospective occupant, is subject to approval and acceptance by owner or his duly authorized property manager.

Additionally, an Application fee of $ (“the Application Fee”) is to be used by the Landlord/Agent for the credit/consumer check and processing the application.

SPECIAL LEASE REQUIREMENTS:

Military/Diplomatic Clause: Yes No

Contingencies/Special Equipment:

OCCUPANTS:

The premises are to be occupied only by the following # of occupants:

Total Number of Occupants:

Name: Age:

Name: Age:

Name: Age:

Name: Age:

Pets: Dog: Breed: Weight: Total Number of Dogs:

Cat Total Number of Cats: Other: How many pets total?

AUTOMOBILES, MOTORCYCLES, TRUCKS, BOATS, AND TRAILERS:

Total Number of Vehicles:

Type/Make: Year: Tag #: State:

Type/Make: Year: Tag #: State:

Are any of the above commercial vehicles? If so, which ones?

In compliance with federal fair housing regulations, the Property shall be made available to all persons without regard to race, color, religion, national origin, sex, physical or mental handicaps, familial status or any additional protected classes specified by State of Maryland or local jurisdiction law.

For Office Use Only: Date

Application Received by Agent/Broker:

APPLICANT INFORMATION

Please Print Legibly:

Applicant's Name:

Birth Date: SS#:

Driver's License # or Government-Issued ID #: State:

Home Phone: Temporary Local # (if applicable):

Office Phone: Mobile Phone:

E-mail Address: E-mail Address:

Current Address:

Own Rent Years: Rent/Mortgage Payments: $

Street: City: State: Zip:

Present Landlord/Agent: Phone:

Reason for moving:

Have you ever paid late? Yes No If yes, Explain:

Have you ever been evicted? Yes No If yes, Explain:

Previous Address:

Landlord/Agent's Name: Phone:

From (Date): To: Monthly Rent: $

Current Employer:

Position: How Long:

Address:

Supervisor: Supervisor’s Phone:

CURRENT GROSS ANNUAL INCOME:

Base Pay: $ Overtime: $

Bonuses: $ Commissions: $

Dividends: $ Other: $ TOTAL: $

Previous Employer:

Position: How Long: Gross Income: $

APPLICANT / CO-APPLICANT

HOUSING ASSISTANCE PROGRAM:

Are you participating in a Housing Assistance Program? Yes No

Jurisdiction: /

Amount: $ /

ASSETS:

Checking Account: $ / Bank: /

Savings Account: $ / Bank: /

Credit Union: $ / Name: /

Other Assets: $ / (Specify) /

LIABILITIES:

(Auto Loans, Mortgages, Credit Cards, Bank Loans, Installment Loans, Student Loans, Child Support, Alimony etc.)

Creditor Total Due Monthly Terms

Creditor: Total Due: $ Monthly Terms: $

Creditor: Total Due: $ Monthly Terms: $

Have you ever filed for bankruptcy? Yes No If yes, Discharge Date:

Do you have a suit for judgments against you? Yes No

Are you obligated to pay or receive child support or pay or receive alimony? Yes No

If so, indicate monthly payment: $

APPLICANT: Citizen of (Country): Passport #:

Emergency Contact: Relationship:

Address: Phone:

CO-APPLICANT: Citizen of (Country): Passport #:

Emergency Contact: Relationship:

Address: Phone:

LOCAL REFERENCES:

Name: Relationship:

Address: Phone:

Name: Relationship:

Address: Phone:

THE FOLLOWING PARAGRAPHS ARE REQUIRED IN MONTGOMERY COUNTY, MARYLAND:

1. In the event the Application is approved, but the Applicant FAILS FOR ANY REASON TO SIGN A LEASE WITHIN THE TIME PROVIDED HEREIN, then the Landlord/Agent SHALL BE ENTITLED TO RETAIN ALL OR A PORTION OF THE APPLICATION FEE AND/OR RETAIN A PORTION OF THE DEPOSIT as specified herein.

2. The provisions of the foregoing Paragraph 1 do not apply to any Landlord/Agent who offers four or less dwelling units for rent on one parcel of property, or at one location, or to seasonal or condominium rentals.

3. I certify that I have received and carefully examined a sample of the lease and any addenda. I agree that I shall apply for all utilities services before taking occupancy of the leased premises and agree to pay all utilities.

4. Should I sign a lease for the above-referenced property managed by Listing Broker/Landlord, I am prepared to deposit with the Listing Broker/Landlord a security deposit in an amount not to exceed the maximum security deposit permitted by law.

ELECTRONIC SIGNATURES:

In accordance with the Uniform Electronic Transactions Act (UETA) and the Electronic Signatures in Global and National Commerce Act, the applicant(s) do hereby expressly authorize and agree to the use of electronic signatures as an additional method of signing and/or initialing this application and/or any future contracts or addenda.

AUTHORIZATION TO RELEASE INFORMATION:

The undersigned applicant affirms under the penalties of perjury that I have read and understand pages 1 through 6 of this application and that my answers to the questions on this application are true and correct to the best of my personal knowledge, information and belief.

The Applicant hereby authorizes Listing Broker/Landlord to order and obtain a credit/consumer report and to investigate and report references, employment, rent history and financial responsibility.

I understand that this APPLICATION DOES NOT CONSTITUTE A COMMITMENT to lease or rent and that a WRITTEN LEASE WILL BE PREPARED if my application is approved.

PRINT NAME:

PRINT NAME:

Leasing Broker: Broker Code:

Address: Phone:

Leasing Agent: Phone:

License #/State: / MRIS #