1. There is a $20 application fee which must be paid BEFORE this application is processed. This must be paid by cash or money order. NO personal checks will be accepted!
2. All adults who will be living in the house must fill out and sign this application.
3. Answer all questions truthfully. All information will be carefully checked. False information will result in Automatic Rejection of this application. If you have questions, call our office.

Address of house you are applying for _____________________________________________________

In Case of Emergency Contact:_________________________

In Case of Emergency Contact:__________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

Number of years at this job _____________ Self employed_________

Number of years at this job _____________ Self employed_________

Title______________________ Type of business _________________

Title______________________ Type of business _________________

WEEKLY INCOME BEFORE TAXES

MONTHLY HOUSING EXPENSES

APPLICANT

CO-APPLICANT

TOTAL

Rent/House Payment

Base Income

House/Renter's Insurance

Overtime

Utilities

Bonuses

Other

Other*

Total

Total Monthly Payment

DESCRIBE OTHER INCOME

`Applicant/Co-Applicant

*Alimony, child support, or separate maintenance income need not be revealed if the Applicant or Co-Applicant does not wish to have it considered as a basis for repaying this loan.

Monthly Income

APPLICANT AND CO-APPLICANT MUST BOTH ANSWER THESE QUESTIONS

ANSWER "YES" or "NO". If "Yes", explain. If you have any questions about this section, please call our office.

Applicant

Co-Applicant

Explanation

Have you declared bankruptcy in the last 2 years?

Have you ever been evicted or asked to leave a property for any reason?

Do you have any unpaid JUDGEMENTS or COLLECTIONS?

Have you ever been involved in a lawsuit as PLAINTIFF or DEFENDANT?

Have you been convicted of a felony or misdemeanor in the last 5 years? (Except minor traffic violations)

Have you ever had a home foreclosed on?

Have you been pre-qualified to purchase a property by a bank or mortgage broker?

Would you be willing to attend low-cost home buyer’s classes?

Do you intend to BUY this home?

Please List Checking Account Numbers and Approximate Balances

Please List Savings Account Numbers and Approximate Balances

Account Number

Approximate Balance

Account Number

Approximate Balance

$

$

$

$

$

$

$

$

Please List All Types of Remodeling Work You Have Performed

Please list owner names and addresses of any major remodeling jobs you have completed

Owner’s Name

Address of Remodeled Property

Type of Work Done

I certify under penalty of legal action that I have answered all of the above questions to the best of my ability. I give permission to ____________________________ to use the provided information for purposes of verifying my qualifications to lease this property.

Applicant’s Signature

Date

Co-Applicant’s Signature

Date