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RENTAL APPLICATION

Equal Housing Opportunity

Birthday
Month
Day
Year
Do you or does anyone living with you smoke?
Yes
No

RESIDENTIAL HISTORY (LAST 3 YEARS)

CREDIT HISTORY

Have you declared bankruptcy in the past seven (7) years?
Yes
No
Have you ever been evicted from a rental residence?
Yes
No
Have you had two or more late rental payments in the past year?
Yes
No
Have you ever willfully or intentionally refused to pay rent when due?
Yes
No

EMPLOYMENT

Your Status
Co-Applicant's Status

ADDITIONAL INFORMATION

I hereby apply to lease the above-described premises (the “Premises”) for the term and upon the conditions set forth in this application, and I acknowledge and agree that rent is payable the first day of each month, in advance. As an inducement to the owner of the property (“Owner”) and to the leasing agent (“Agent”), to accept this application, I represent and warrant that all statements made in this application are true and correct; however, should any statement made in this application be untrue, incorrect or a misrepresentation of fact(s), I agree that my application will be denied and my Application Fee (defined below) will be retained by Agent to offset the agent's cost, time, and effort in processing my application.

I hereby deliver to Agent, $________________ as an application fee (“Application Fee”) in connection with my application to lease the Premises. Except as otherwise provided in this application, the Application Fee will be refunded to me if this application is not accepted by Owner within three (3) business days. Upon acceptance, the Application Fee shall be retained as part payment of the security deposit due under the lease for the Premises. If my application is so approved and accepted, within three (3) business days, I agree to execute a lease for the Premises

for a term of (12) months before possession is given, using Owner’s standard lease form. I agree to pay the balance of the security deposit at the time I execute the lease. To the maximum extent permitted by law, if my application is not approved or accepted by Owner, I agree that the refund of the Application Fee will be my sole remedy, and I hereby waive any claim for damages by reason of non-acceptance of my application. If I withdraw my application for any reason, I agree that the Application Fee will be retained by Agent to offset Agent's cost, time, and effort in processing my application. Additionally, if I fail to execute a lease for the Premises using Owner’s standard lease form, within three (3) business days after acceptance of this application, I agree that the Application Fee will be retained by Agent to offset Agent's cost, time, and effort in processing my application.

I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared, whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.

Date
Month
Day
Year

AUTHORIZATION

RELEASE OF INFORMATION

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner/manager.

Date
Month
Day
Year

928-830-0004

201 N Alarcon St, Ste F

Prescott, AZ  86301

SA691335000

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