PICERNE REAL ESTATE GROUP
Picerne Real Estate Group Rental Application Equal Housing Opportunity
Please print or type on top of lines provided. Each applicant must submit a separate application.
Applicant's Name A P P L I C A N T
(
)
D.O.B.
-
(
Home Phone #
)
-
(
Work Phone #
-
Apt. #
(
E.C.'s Home Phone #
Email address
Relationship to you
Emergency Contact's (E.C.) Address
)
-
Cell Phone #
Emergency Contact's (E.C.) Name
(
Soc. Sec. #
)
)
City
-
(
E.C.'s Work Phone #
State
)
Zip Code
-
E.C.'s Cell Phone #
E.C.'s Email address
3 Y E A R R E S I D E N C Y
Present Street Address Dates: From - To
Own home?
Rent
Landlord's Name City
Rent
Landlord's Name Apt. #
Current Employer (1)
)
City
State
( Rent
Zip Code
-
Landlord's Phone #
$
Own home?
-
State
(
Previous Street Address (2)
Yes / No
)
Landlord's Phone #
$
Own home?
Zip Code
State
(
Apt. #
Yes / No Dates: From - To
City
$
Previous Street Address (1)
Dates: From - To
I N C O M E
Apt. #
Yes / No
Landlord's Name
)
Zip Code
-
Landlord's Phone #
Employer's Street Address
City
State
Zip Code
$ Position
Dates: From - To
( Verification Contact
)
-
Annual Gross Income
(
Contact's Phone #
)
-
Contact's Fax #
Contact's Email address
& A S S E T S
Current Employer (2) - if applicable
Employer's Street Address
City
State
Zip Code
$ Position
Dates: From - To
( Verification Contact
)
-
Annual Gross Income
(
Contact's Phone #
)
-
Contact's Fax #
Contact's Email address
$ Amount of Other Income/Assets
Source of Other Income/Assets
Yes / No O T H E R
Other Occupant's Name: Co-applicant / Dependant
D.O.B.
Do you own a pet?
If "Yes," describe
Other Occupant's Name: Co-applicant / Dependant
D.O.B.
How did you hear about us?
Other Occupant's Name: Co-applicant / Dependant
D.O.B.
Vehicle Year
Co-signer / Guarantor
D.O.B.
License Plate / Issuing State
Color
Make & Model
Driver's License # / Issuing State
FOR OFFICE USE ONLY Monthly Rent Apartment: $
Property:
Balance due prior to Move-in
Apt. #:
Apt. Address:
Pro-rate: $
Furniture Fees: $ Parking Fees: $ Other Fees: $ Total Monthly Rent: $
1st Month's Rent: $ Apt. Size:
Lease From: # of Occupants:
Make checks payable to: Comments:
Floor:
Security Deposit: $
Date of Possession:
Pet Fee: $ To:
Credit on Account: $(
)
Total Due*: $
Agent:
*Balance due prior to move-in is subject to change and must be paid in the form of a Certified Check or Money Order.
Received a non-refundable application fee of $____________ and a holding deposit of $____________ with Check or Money Order #_______________________ on _______________________ which is considered the date of application. This application will be processed in accordance with the applicable property's Resident Selection Criteria Policy in effect on the date of application. I hereby authorize Owner/Agent to obtain consumer reports, and any other information it deems necessary, for the purpose of evaluating my application. I understand that such information may include, but is not limited to, credit history, civil and criminal information, records of arrest, rental history, employment/salary details, vehicle records, licensing records, and/or any other necessary information. I understand that subsequent consumer reports may be obtained and utilized under this authorization in connection with an update, renewal, extension or collection with respect or in connection with the rental or lease of a residence for which application was made. I hereby expressly release Owner/Agent, and any procurer or furnisher of information, from any liability what-so-ever in the use, procurement, or furnishing of such information, and understand that my application information may be provided to various local, state and/or federal government agencies, including without limitation, various law enforcement agencies.
revised 1/07
Applicant's printed name Applicant's signature
Date
Owner/Agent's signature
Date
Date:____________ Thankyouforchoosing_________________________________as yournew home.W e lookforward tohavingyouas aresident.Please be aware t hatwe require the following informationtoapprove yourfile within72hours: F F F F F F
Proofofsocialsecuritynumber Landlord’s name and phone number M ostrecentpaystuborbankstatement(perapplicant) Supervisor’s name and phone number Other:________________________________ Other:________________________________
Deadl ine:________________ Afteryourfile has beenapproved,youhave 7 days tosubmitthe balance ofthe holding depositinfull. Amount:$__________________ Ifyoufailtosupplymanagementwiththe above requested informationbythe given deadline,managementhas the righttocancelyourappl icat ion.Al lcancellations after72 hours ofapplicationdate willresultinthe loss ofthe fullholdingdepositonaccount. Thankyouforyouranticipated cooperation.W e lookforward toseeingyou,atthe _____________________________rentaloffice on_______________@ ____________ tosignyourlease.
ApplicantSignature
Date
ApplicantSignature
Date
ApplicantSignature
Date
ApplicantSignature
Date
Revised 7/18/06
APPLICANT CONSENT TO TENANT SCREENING I authorize RentGrow, Inc. dba Yardi Resident Screening (“YRS”) to investigate the information provided by me or about me in connection with my application to lease a rental home or apartment from __________________________________ or its management company (the “Landlord”). I personally completed the application form and/or reviewed and confirmed all information provided on the completed application. I hereby certify and declare that all of the information provided by me in connection with my application to lease an apartment or continue leasing an apartment from the Landlord is true and correct. An investigation by YRS may include assembly and merger of my credit, criminal, and eviction records. I understand and acknowledge that YRS furnishes consumer reports to property and apartment community managers, and does not itself approve or deny applicants. My signature below authorizes all entities listed on the lease application to release credit, criminal, and eviction record information. Printed Name of Applicant: Applicant Signature: Date: If there are multiple applicants, each person must provide consent below. Printed Name of Co-Applicant: Co-Applicant Signature: Date: Printed Name of Additional Co-Applicant: Additional Co-Applicant Signature: Date: Printed Name of Additional Co-Applicant: Additional Co-Applicant Signature: Date:
307 Waverly Oaks Road, Suite 301, Waltham MA 02452 | Tel. (800) 736-8476 | [email protected] ©2013 RentGrow, Inc. dba Yardi Resident Screening. All rights reserved.
Please print or type on top of lines provided. Each applicant must submit a separate application.
Applicant's Name A P P L I C A N T
(
)
D.O.B.
-
(
Home Phone #
)
-
(
Work Phone #
-
Apt. #
(
E.C.'s Home Phone #
Email address
Relationship to you
Emergency Contact's (E.C.) Address
)
-
Cell Phone #
Emergency Contact's (E.C.) Name
(
Soc. Sec. #
)
)
City
-
(
E.C.'s Work Phone #
State
)
Zip Code
-
E.C.'s Cell Phone #
E.C.'s Email address
3 Y E A R R E S I D E N C Y
Present Street Address Dates: From - To
Own home?
Rent
Landlord's Name City
Rent
Landlord's Name Apt. #
Current Employer (1)
)
City
State
( Rent
Zip Code
-
Landlord's Phone #
$
Own home?
-
State
(
Previous Street Address (2)
Yes / No
)
Landlord's Phone #
$
Own home?
Zip Code
State
(
Apt. #
Yes / No Dates: From - To
City
$
Previous Street Address (1)
Dates: From - To
I N C O M E
Apt. #
Yes / No
Landlord's Name
)
Zip Code
-
Landlord's Phone #
Employer's Street Address
City
State
Zip Code
$ Position
Dates: From - To
( Verification Contact
)
-
Annual Gross Income
(
Contact's Phone #
)
-
Contact's Fax #
Contact's Email address
& A S S E T S
Current Employer (2) - if applicable
Employer's Street Address
City
State
Zip Code
$ Position
Dates: From - To
( Verification Contact
)
-
Annual Gross Income
(
Contact's Phone #
)
-
Contact's Fax #
Contact's Email address
$ Amount of Other Income/Assets
Source of Other Income/Assets
Yes / No O T H E R
Other Occupant's Name: Co-applicant / Dependant
D.O.B.
Do you own a pet?
If "Yes," describe
Other Occupant's Name: Co-applicant / Dependant
D.O.B.
How did you hear about us?
Other Occupant's Name: Co-applicant / Dependant
D.O.B.
Vehicle Year
Co-signer / Guarantor
D.O.B.
License Plate / Issuing State
Color
Make & Model
Driver's License # / Issuing State
FOR OFFICE USE ONLY Monthly Rent Apartment: $
Property:
Balance due prior to Move-in
Apt. #:
Apt. Address:
Pro-rate: $
Furniture Fees: $ Parking Fees: $ Other Fees: $ Total Monthly Rent: $
1st Month's Rent: $ Apt. Size:
Lease From: # of Occupants:
Make checks payable to: Comments:
Floor:
Security Deposit: $
Date of Possession:
Pet Fee: $ To:
Credit on Account: $(
)
Total Due*: $
Agent:
*Balance due prior to move-in is subject to change and must be paid in the form of a Certified Check or Money Order.
Received a non-refundable application fee of $____________ and a holding deposit of $____________ with Check or Money Order #_______________________ on _______________________ which is considered the date of application. This application will be processed in accordance with the applicable property's Resident Selection Criteria Policy in effect on the date of application. I hereby authorize Owner/Agent to obtain consumer reports, and any other information it deems necessary, for the purpose of evaluating my application. I understand that such information may include, but is not limited to, credit history, civil and criminal information, records of arrest, rental history, employment/salary details, vehicle records, licensing records, and/or any other necessary information. I understand that subsequent consumer reports may be obtained and utilized under this authorization in connection with an update, renewal, extension or collection with respect or in connection with the rental or lease of a residence for which application was made. I hereby expressly release Owner/Agent, and any procurer or furnisher of information, from any liability what-so-ever in the use, procurement, or furnishing of such information, and understand that my application information may be provided to various local, state and/or federal government agencies, including without limitation, various law enforcement agencies.
revised 1/07
Applicant's printed name Applicant's signature
Date
Owner/Agent's signature
Date
Date:____________ Thankyouforchoosing_________________________________as yournew home.W e lookforward tohavingyouas aresident.Please be aware t hatwe require the following informationtoapprove yourfile within72hours: F F F F F F
Proofofsocialsecuritynumber Landlord’s name and phone number M ostrecentpaystuborbankstatement(perapplicant) Supervisor’s name and phone number Other:________________________________ Other:________________________________
Deadl ine:________________ Afteryourfile has beenapproved,youhave 7 days tosubmitthe balance ofthe holding depositinfull. Amount:$__________________ Ifyoufailtosupplymanagementwiththe above requested informationbythe given deadline,managementhas the righttocancelyourappl icat ion.Al lcancellations after72 hours ofapplicationdate willresultinthe loss ofthe fullholdingdepositonaccount. Thankyouforyouranticipated cooperation.W e lookforward toseeingyou,atthe _____________________________rentaloffice on_______________@ ____________ tosignyourlease.
ApplicantSignature
Date
ApplicantSignature
Date
ApplicantSignature
Date
ApplicantSignature
Date
Revised 7/18/06
APPLICANT CONSENT TO TENANT SCREENING I authorize RentGrow, Inc. dba Yardi Resident Screening (“YRS”) to investigate the information provided by me or about me in connection with my application to lease a rental home or apartment from __________________________________ or its management company (the “Landlord”). I personally completed the application form and/or reviewed and confirmed all information provided on the completed application. I hereby certify and declare that all of the information provided by me in connection with my application to lease an apartment or continue leasing an apartment from the Landlord is true and correct. An investigation by YRS may include assembly and merger of my credit, criminal, and eviction records. I understand and acknowledge that YRS furnishes consumer reports to property and apartment community managers, and does not itself approve or deny applicants. My signature below authorizes all entities listed on the lease application to release credit, criminal, and eviction record information. Printed Name of Applicant: Applicant Signature: Date: If there are multiple applicants, each person must provide consent below. Printed Name of Co-Applicant: Co-Applicant Signature: Date: Printed Name of Additional Co-Applicant: Additional Co-Applicant Signature: Date: Printed Name of Additional Co-Applicant: Additional Co-Applicant Signature: Date:
307 Waverly Oaks Road, Suite 301, Waltham MA 02452 | Tel. (800) 736-8476 | [email protected] ©2013 RentGrow, Inc. dba Yardi Resident Screening. All rights reserved.
