Single > yes [ ] no [ ]
Married to this person > yes [ ] no [
]
PLEASE FILL OUT COMPLETELY AND FAX TO (727) 786-1003
RENTAL APPLICATION
EACH ADULT APPLYING FOR UNIT MUST COMPLETE A SEPARATE APPLICATION
PLEASE PRINT – ALL information must be
completed. All blanks must be filled in.
The decision to rent to you will depend in great
part on your credit history and references.
Only clean, responsible people who pay rent on
time, need apply.
How did you find out about us? Sign __ Newspaper __ Friend __ Other __________________________
YOUR PERSONAL INFORMATION
Full name ________________________________Phone (______)__________________Work (______)_________________
Social Security Number _________-_____-_________ Current Driver’s License #__________________________ State _________
Present Address_______________________________________________________________________________________
City________________________________________________ State________ Zip______________________
How Long? _____ If renting, Apartment name/location _______________________ Phone (____)_______
Landlord/Mgr’s name __________________________________________ Alternate Phone(____)_________
Why are you leaving?
___________________________________________________________________
__________________________________________________________ Current Rent: $__________________
Previous Address_____________________________________________________________________________________
City_____________________________________ State __________ Zip __________________
How Long? _____ If renting, Apartment name/location ________________________ Phone (____)_________
Landlord/Mgr’s name __________________________________________ Alternate Phone (____)__________
Why did you
leave? _______________________________________________________________________
__________________________________________________________ Current Rent:
$_________________
Present Employer _________________________________ Position _____________________ How long?___________
Address ________________________________________________________Phone (____)_______________
Gross Monthly Income before deductions $ _____________ Other Income $ ____________ Source _____________
Former Employer ____________________________________ Position ________________________ How Long? ___________
Address ___________________________________________________Phone (____)_______________
Why did you leave _____________________________________________________________________
PLEASE CONTINUE ON NEXT PAGE
OTHER INFORMATION
OTHER PERSONS (INCLUDING CHILDREN) WHO WILL LIVE IN THE DWELLING UNIT
Name _____________________________ Age _____ Name _______________________________ Age ______
Name _____________________________ Age _____ Name _________________________________ Age _______
*Pets
Name
____________________Type ____________________ Weight_________lbs. Age
_____________
Name ____________________Type ____________________Weight _________lbs. Age _____________
*NOTE: No pets are allowed at any time on the premises without prior Management consent and payment of fees – NO EXCEPTIONS
Date of desired occupancy _________________________ Anticipated length of stay ______________________________
Do you own: Vacuum cleaner ____ Lawn mower ____ Water Bed _____ Musical Instruments ______ Does anyone smoke? Yes ___ No___
List all motor vehicles, including recreational vehicles, to be kept at the property:
MAKE MODEL COLOR YEAR LICENSE PLATE # STATE MONTHLY PAYMENT
__________ ___________ _________ ________ __________________ ________ $ ______________
__________ ___________ _________ ________ __________________ ________ $ ______________
__________ ___________ _________ ________ __________________ ________ $ _____________
__________ ___________ _________ ________ __________________ ________ $ ______________
A non-refundable application fee of $ ______________ and a reservation fee of $ _______________ are required for processing this
Application, and is being paid herewith. The undersigned expressly agrees that if this application is approved applicant herewith agrees to rent this property. Applicant further agrees that if applicant is accepted by Management and then decides, for any reason, not to move into the premises, then all monies paid herewith shell be retained as liquidated damages since other prospective tenants may have been turned away and it may be necessary for Management to re-advertise the property and evaluate other applicants. Processing of this application shall be as timely as possible and the results may be delivered via telephone, fax or mail. Once approved, applicant agrees to pay the balance of funds and complete the paperwork within 48 hours, otherwise Management will assume that applicant has decided to forfeit the reservation/earnest money payment made herewith and will begin re-marketing the property. If applicant is not approved, all monies given herewith, less application fee shown above, shall be returned to applicant. Applicant understands and agrees that rent begins as of the day after application approval and will be prorated for the following month.
A PHOTOSTATIC COPY OF MY DRIVER’S LICENSE OR PICTURE IDENTIFICATION CARD, SOCIAL SECURITY CARD, LATEST PAY CHECK STUB(S) AND LAST YEAR’S W-2 (s) OR COPY OF LAST YEARS INCOME TAX RETURN ARE ATTACHED TO THE APPLICATION ( ), OR WILL BE PROVIDED ( ). I declare that the application is complete, true and correct and I herewith give my permission for anyone contacted to release the credit or personal information of the undersigned applicant to Management or their authorized agents, at any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended. I further authorize Management or their Authorized Agents to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employers and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement entered into with Management. Any false information will constitute grounds for rejections of this application, or Management may at any time immediately terminate any agreement enter into in reliance upon misinformation given on this application.
___________________________________________________ ____________________________
Applicant’s Signature Date
Fax application to (727) 786-1003 or mail to:
HomeBuyers Gulf Coast
847 Tampa Rd, Palm Harbor, FL 34683
CREDIT REFERENCES: This can include store credit cards, rental stores, car loans, small loans, etc.
Bank ______________________Acct #(s)_____________________Branch__________ Checking [ ] Savings [ ] Loans [ ]
City_____________________ State __________ Approx. Balance $ _________________ How long? _________________
Other Active Credit Ref: ________________________ Account # ____________________ Exp. Date _________________
Type of Account ____________ Credit Limit $ ________ How long? _________ Are all payments current? Yes [ ] No [ ]
Other Active Credit Ref: _______________________ Account # ______________________ Exp. Date ______________
Type of Account __________ Credit Limit $ ____________ How long? ___________ Are all payments current? Yes [ ] No [ ]
Have you ever been evicted? Yes [ ] No [ ] Have you ever had a foreclosure/repossession? Yes [ ] Date________ No [ ]
If yes, explain: __________________________________________________________________________________
Have you ever filed for Bankruptcy? Yes [ ] Date ___________ No [ ] If yes, Chapter 7 [ ] or Chapter 13 [ ] ?
If yes, explain: _________________________________________________________________________________
Have you ever been convicted of a crime, other than a traffic violation? Yes [ ] No [ ]
If yes, explain: __________________________________________________________________________________
PERSONAL REFERENCES: List three persons, OTHER THAN YOUR RELATIVES, that we may contact to verify your character.
Name __________________________________Relationship______________________Phone (_____)_______________
Address _________________________________________City_______________________State ______ Zip __________
Name __________________________________Relationship______________________Phone (_____)_______________
Address _________________________________________City_______________________State ______ Zip __________
Name ___________________________________Relationship______________________Phone (_____)_______________
Address __________________________________________City_______________________State ______ Zip __________
EMERGENCY: In an emergency you may contact (List two, other than spouse/roommate, nearest relatives first)
Name ___________________________________Relationship______________________Phone (_____)_______________
Address __________________________________________City_______________________State ______ Zip __________
Name ___________________________________Relationship______________________Phone (_____)_______________
Address ___________________________________________City_______________________State ______ Zip __________
PLEASE CONTINUE ON NEXT PAGE
TENANT INFORMATION FORM
Customer # 552 Date__________
I/We,__________________________________________________________prospective tenants/buyers for
property located at _______________________________________________________
Owned by MDJ Holdings, Inc. Hereby allow TENENT CHECK, and/or the property owner/manager to inquire into my/our credit file, criminal, and rental history to obtain information. I/we understand that on my/our credit file it will appear that TENANT CHECK has made an inquiry. I/we cannot claim any invasion of privacy against them now or in the future.
TENANT INFORMATION: SPOUSE OR ROOMMATE:
Single > yes [ ] no [ ]
Married to this person > yes [ ] no [
]
SS# SS#
Full Name
Full Name
Birth
Date
Birth Date
Present
Address
Present Address
How Long How Long
Landlord & Ph # Landlord & Ph #
Previous
Address
Previous Address
Employer
Employer
How long Work# How long Work #
Gross Monthly Income
Gross Monthly Income
Ever been arrested Ever been arrested
Ever been evicted Ever been evicted
Drivers Lic # Drivers Lic #
Signature Signature
Your Phone #
PLEASE FILL OUT COMPLETELY AND FAX TO (727) 786-1003