GLVAR Application Form

RENTAL APPLICATION

REQUIRED TO SUBMIT:

PROPERTY ADDRESS

CITY, STATE, ZIP

MOVE-IN DATE

EVIDENCE BY: CASH CHECK CASHIER'S CHECK MONEY ORDER

APPLICANT:

APPLICANT NAME

HOME PHONE #   OTHER PHONE

EMAIL   SSN#

DL#   STATE   BIRTH DATE

CURRENT ADDRESS:

Street Address

CITY, STATE, ZIP

LANDLORD NAME / MORTGAGE HOLDER:   PHONE #

HOW LONG?   (PLEASE CHECK ONE) OWNED RENT

REASON FOR LEAVING

PRIOR STREET ADDRESS:

Street Address

CITY, STATE, ZIP

LANDLORD NAME / MORTGAGE HOLDER:   PHONE #

HOW LONG?   (PLEASE CHECK ONE) OWNED RENT

REASON FOR LEAVING

CURRENT EMPLOYER:

CURRENT EMPLOYER

HOW LONG?   EMPLOYED AS

ADDRESS

CITY, STATE, ZIP

PHONE #   FAX#

CO-APPLICANT:

CO-APPLICANT NAME

PHONE #   EMAIL

CURRENT ADDRESS

CITY, STATE, ZIP

LANDLORD NAME / MORTGAGE HOLDER:   PAYMENT:

PHONE #   HOW LONG?   (PLEASE CHECK ONE) OWNED RENT

PRIOR STREET ADDRESS:

Street Address

CITY, STATE, ZIP

LANDLORD NAME / MORTGAGE HOLDER:

PHONE #   HOW LONG?   (PLEASE CHECK ONE) OWNED RENT

REASON FOR LEAVING

CURRENT EMPLOYER:

CURRENT EMPLOYER

HOW LONG?   EMPLOYED AS

ADDRESS

CITY, STATE, ZIP

PHONE #   FAX#

SALARY: $   PER/MO SUPERVISOR:

OTHER INCOME: SOURCE   AMOUNT: $

PRIOR EMPLOYER (IF LESS THAN 3 YEARS):

PRIOR EMPLOYER   PHONE #

HOW LONG?   EMPLOYED AS

SALARY: $   PER/MO SUPERVISOR:

CREDIT REFERENCES:

BANK ACCT.#

ADDRESS

AUTOMOBILES:

MAKE MODEL LIC# STATE YR COLOR

MAKE MODEL LIC# STATE YR COLOR

MAKE MODEL LIC# STATE YR COLOR

IN ADDITION TO APPLICANT(S), OTHER PERSONS TO BE AT PREMISES:

NAME   RELATIONSHIP   AGE   OCCUPATION

NAME   RELATIONSHIP   AGE   OCCUPATION

NAME   RELATIONSHIP   AGE   OCCUPATION

PETS? (Y/N)   HOW MANY? Cats Dogs Other

If Other, please explain:

HAS ANY APPLICANT EVER FILED BANKRUPTCY? YES / NO   GIVE DETAILS

HAS ANY APPLICANT EVER BEEN EVICTED? YES / NO   EXPLAIN

HAS ANY APPLICANT EVER WILLFULLY REFUSED TO PAY RENT WHEN DUE? YES / NO   EXPLAIN

HAS ANY APPLICANT OR OCCUPANT EVER BEEN CONVICTED OF A GROSS MISDEMEANOR OR FELONY? YES NO IF YES PLEASE EXPLAIN

HOW LONG DOES APPLICANT PLAN TO LIVE HERE?   DOES APPLICANT PLAN TO USE LIQUID FILLED FURNITURE?

DOES ANYONE IN THE HOUSEHOLD SMOKE? Y/N

APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY:

NAME

RELATIONSHIP:   PHONE #

CO-APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY:

NAME

RELATIONSHIP:   PHONE #

DISCLOSURE

PLEASE READ CAREFULLY BEFORE SIGNING

1. APPLICANT UNDERSTANDS THAT IS THE LEASING AGENT AND REPRESENTATIVE FOR THE LANDLORD OF THE PREMISES LOCATED AT AT A MONTHLY RENT OF $

2. APPLICANT DECLARES THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT, AND APPLICANT AUTHORIZES AN EMPLOYMENT CHECK, CRIMINAL RECORDS CHECK, CREDIT CHECK, VERIFICATION OF REFERENCES AND CURRENT AND PREVIOUS LANDLORDS.

3. APPLICANT HEREBY PAYS $ AS A NON-REFUNDABLE APPLICATION FEE AND $ AS HOLDING DEPOSIT. IF APPLICANT IS DECLINED, HOLDING DEPOSIT SHALL BE REFUNDED WITHIN BUSINESS DAYS.

4. APPLICANT AGREES TO EXECUTE A RENTAL AGREEMENT BEFORE POSSESSION IS GIVEN AND TO PAY THE RENT AND SECURITY DEPOSIT WITHIN BUSINESS DAYS AFTER BEING NOTIFIED OF ACCEPTANCE OF THIS APPLICANT.

5. LANDLORD AND AGENT WILL NOT BE BOUND BY ANY REPRESENTATIONS, AGREEMENTS OR PROMISES, WRITTEN OR ORAL, MADE BY LANDLORD OR AGENT UNLESS CONTAINED IN THE RENTAL AGREEMENT SIGNED BY LANDLORD OR LANDLORD'S AGENT.

6. APPLICANT DOES HEREBY RELEASE LANDLORD, AGENT AND THIS COMPANY FROM ANY AND ALL DAMAGES OR LIABILITIES WHICH MIGHT RESULT FROM THE ABOVE INFORMATION.

7. APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT A FALSE STATEMENT MADE HEREIN IS GROUNDS FOR DENIAL OF RENTAL TO APPLICANT.

8. APPROVAL FOR RESIDENCY IS MADE WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, OR HANDICAP.

9. APPLICANT UNDERSTANDS THAT APPLICANT ACQUIRES NO RIGHTS TO PREMISES UNTIL EXECUTION OF A RENTAL AGREEMENT IN THE FORM SUBMITTED AND DEPOSIT OF RENT AND SECURITY DESCRIBED ABOVE.

OFFICE USE ONLY:

REFERRAL COMPANY   AGENT:   P.I.D. #

MLS #   DATE PAID   LICENSE #