Zip: How Long at
Date of Birth: SS #:
Expected Move in Date:
Landlord's Name & Address & Phone:
Zip: How Long at Address:
How Long at Address:
Why are you leaving your present residence?
Have you or your spouse ever left owing rent?
Have you or your spouse ever been evicted?
Have you or your spouse ever been convicted of a felony
Present Employer: Phone
Position: Dates of Employment:
Previous Employer: Phone
Other Income:$ Describe
Spouse's Present Employer:
Do you have a Pet?
Do you own Real Estate?
Person to be Notified in Event of Emergency:
I (we) hereby apply for occupancy of apartment no._____ located at
________________ and agree to take the premises and execute an apartment lease
in form used by the Owner.
I (we) hereby make an earnest money deposit of $300.00 which is to be
forfeited and retained by the Owner if balance of deposit, equaling $_________
is not paid by the due date. (Due date is 10 days after selection of an
apartment or before move-in date, whichever occurs first.) If this
application is NOT accepted, or if I (we) cancel the application within 3 days
of application, the earnest money deposit will be refunded within 30 days of
application. The Owner will retain the credit check fee.
I (we) acknowledge that the selection of an apartment will cause the Owner
to remove that apartment from the market, so that if I (we) fail to occupy the
apartment, the Owner will incur monetary damages which are certain to occur
but difficult to calculate. Therefore, if I (we) fail to occupy the
apartments, the entire amount of this deposit shall be considered liquidated
damages and shall be retained by the Owner. If I (we) occupy the
apartment, the entire amount of this deposit shall be converted to the
security deposit required under the lease.
I (we) represent that all of the above statements are true and correct and
hereby consent to allow Premier Realty and Management Group, L.L.C., Inc., through its designated agent and its
employees, to obtain and verify my credit information including a criminal
background search for the purpose of determining whether or not to lease me/us
an apartment. I (we) understand that should I lease an apartment,
Premier Realty and Management Group, L.L.C. and its agent shall have a continuing right to review my credit
information, rental application, criminal background, payment history and
occupancy history for account review and collection purposes. I (we)
understand that falsifying of information on the application will be grounds
for rejection of tenancy.