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					BURTON PROPERTIES N12099 STATE ROAD 79, DOWNING WI 54734 OFFICE-760-203-2260 FAX-760-203-0170 APPLICATION TO RENT

NAME: ___________________________________________________________________________________________________________ LAST FIRST MIDDLE WORK PHONE HOME PHONE ___________________________________________________________________________________________________________ SPOUSE LAST FIRST MIDDLE WORK PHONE HOME PHONE ALL PERSONS WHO WILL OCCUPY DWELLING: Full Name Date of Birth Relationship _______________________________________________________________________________________Occupant____________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ RESIDENCE: Current:____________________________________________________________________________________________________ Street Address/Apt # City State Zip Code From___________to_____________Amount paid monthly_______________Reason for leaving_____________________________ Month/Year Month/Year Landlord/Mortgage Co:___________________________________________________Phone________________________________ ______________________________________________________________________ __________________________________ Address Loan/Account # Prior Address:_______________________________________________________________________________________________ Street Address/Apt # City State Zip Code From__________to_____________Amount paid monthly______________Reason for leaving_______________________________ Month/Year Month/Year Landlord/Mortgage Co: ___________________________________________________Phone________________________________ _______________________________________________________________________ __________________________________ Address Loan/Account # EMPLOYMENT - Occupant Current: Company Name__________________________________________________Phone_______________________________ ________________________________________________________________________ _________________________________ Address Supervisor name & position From_________to____________Gross Monthly Salary$____________________Position___________________________________ Prior: Company Name__________________________________________________Phone_______________________________ ________________________________________________________________________ _________________________________ Address Supervisor name & position From_________to____________Gross Monthly Salary$____________________Position___________________________________ EMPLOYMENT -Spouse Current: Company Name__________________________________________________Phone_______________________________ ________________________________________________________________________ _________________________________ Address Supervisor name & position From_______ to ___________Gross Monthly Salary$____________________Position___________________________________ Prior: Company Name__________________________________________________Phone_______________________________ ________________________________________________________________________ _________________________________ Address Supervisor name & position From_______ to ___________Gross Monthly Salary$____________________Position___________________________________

Any other Income:_______________________________________________________________________________________ (If you are in the Military you must include your LES with this application.)
IDENTIFICATION: Valid Identification:__________________________________________________________________________________________ (I.E. Drivers Lic) ID # State of Issuance Date of Birth Social Security Card_______________________________Other:_____________________________________________________ SS # ID #/Type Spouse’s information: SS#_______________________Driver’s License #__________________________Date of Birth__________ Mother’s Maiden Name:_______________________________________________________________________________________ IN CASE OF EMERGENCY: Family Contact:_____________________________________________________________________________________________ Name Phone ___________________________________________________________________________________________________________ Address Relationship Other Contact:______________________________________________________________________________________________ Name Phone __________________________________________________________________________________________________________ Address Relationship LIST ALL VEHICLES TO BE PARKED ON PREMISES: Year Make Model Color License # ___________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ __________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ADDITIONAL INFORMATION: Do you have pets? Yes/No Number & Description:________________________________________________________________ Do you have a large screen television/surround sound system/aquarium/water bed/other water filled furniture? Yes/No Have you ever been evicted for non-payment of rent? Yes/No Explain: ________________________________________________ Have you ever been evicted for any other reason? Yes/No Explain: _________________________________________________ Have you had any Landlord problems? Yes/No Explain: __________________________________________________ Have you ever been late on any financial obligation? Yes/No Explain: __________________________________________________ I am applying for the following rental unit, but understand that by remitting this application Burton Properties is under no obligation to rent this or any other unit to me. I further understand that if this unit is rented by another party and I want to apply for another available unit, Burton Properties may request an additional application and fee if the occurrence is more than one week from the time this application is submitted to Burton Properties for processing. Rental Unit applied for:_______________________________________________________________________________________ The information on this application is true and correct to the best of my knowledge. I hereby authorize Burton Properties or their agents to verify the above information and to obtain a consumer and/or investigative credit and data report. I understand that the fee for verifying this application is not a deposit or rent and will not be applied to rent or deposit or refunded even if this application is denied. I have further read the attached Rental Policy section of this application and agree to it. ________________________________________________________________________ Applicant’s Signature _______________________________ Date

________________________________________________________________________ Applicant’s Signature

________________________________ Date

APPLICANT’S AUTHORIZATION FOR RELEASE OF INFORMATION To:_____Kelly, Angie or Betty_______________________________________ Company Name:__Burton Properties_________________________________________ Applicant’s Name: ________________________________________________________ Applicant Current Address: _________________________________________________ The person named above has applied for rental with Burton Properties. You and/or your firm have been named by this applicant as a reference as having currently or previously either employed, rented to, extended credit to, or have had financial dealings with this person. The applicant is hereby authorizing you to release the requested information to us. Your timely cooperation in providing accurate date is greatly appreciated. If you would like to speak to me directly, you can call me @ 760-203-2260. Please return the questionnaire by facsimile to 760-203-0170 (fax) In consideration of my application, I authorize, without any reservation, Burton Properties and CreditLink Corporation and/or it’s agents to conduct and report research and share with each other, information about my background including, but not limited to: information about my past and current employment, consumer credit history, criminal record, and general public history. I further authorize the research into the truthfulness of any information provided by me in this application process and any information found as subsequent to any research done. I understand that any investigative consumer report requested will be used as defined under the Fair Credit Reporting Act. I release CreditLink Corporation and it’s agents, their respective officers, directors, employees, and all persons, agencies, and entities providing information or report about me from all liability arising out of the release of any such information or reports. I further understand that Burton Properties may use this authorization form to obtain information relevant to my application and/or tenancy not only during the application process but also during or after tenancy (should I be granted tenancy). X__________________________________________________________________________________Applicant’s Signature/Date ********************************************************************************************************** EMPLOYER TO FILL OUT THIS SECTION ONLY Does the above name match your records? ___________________________________________ Yes/No Does the above address provided match your records? __________________________________ Yes/No Social Security Number on file matches? ____________________________________________ Yes/No Employee’s Position or Department: ________________________________________________ Dates of Employment: from__________________to__________________________________ Gross Monthly Salary/Wages: ____________________________________________________ Or Hourly Wage:____________________________Average Hours per week:__________ Other Comments:______________________________________________________________________________________ Employer Signature/Title/Date:____________________________________________________________________________ (EMPLOYER, RETURN TO FAX # 760-203-0170) **********************************************************************************************************

THERE IS A $40.00 APPLICATION FEE FOR COUPLES AND $20.00 APPLICATION FEE FOR SINGLE PERSON. THE APPLICATION FEE NEEDS TO BE PAID AT THE TIME OF APPLICATION BY MONEY ORDER OR CREDIT CARD.
The above amount is to be used to screen Applicant with regards to credit history and other background information. Applicant authorized verification of information by his/her signature on Application to Rent submitted to Burton Properties.

Applicant Signature:_______________________________________Date:_____________________________ Applicant Signature:_______________________________________Date:_____________________________

BURTON PROPERTIES
N12099 STATE ROAD 79, DOWNING WI 54734 OFFICE-760-203-2260 FAX-760-203-0170

Privacy Policy on Personal Information
We are dedicated to protecting the privacy of your information. This includes your Social Security or other government identification numbers. Our privacy policy is to help assure you that your information is kept secure. We follow all federal and state laws regarding the protection of your personal information. How information is collected. You will be furnishing some of your personal information (such as your Social Security or other governmental identification numbers) at the time you apply to rent from us. This information will be on the rental application form or other documents that you provide to us either on paper or electronically. How and when information is used. We may use this information in the process of verifying statements made on your rental application, such as your rental, credit and employment history. We may use the information when reviewing any lease renewal. We may also use it to assist us in obtaining payment from you for any money you may owe in the future. How the information is protected and who has access. Only authorized persons have access to your Social Security or other governmental identification numbers. We keep all documents containing this information in a secure area, accessible only by authorized persons. We limit access to electronic versions of the information to authorized persons only. How the information is disposed of. After we no longer need your Social Security or other governmental identification numbers, we will store or destroy the information in a manner that ensures that no unauthorized person will have access to it. Our disposal method may include physical destruction or obliteration of paper documents or electronic files containing such information. Locator Services. If you were referred by a locator service, please be aware that the locator services are independent contractors and are not our employees-even though they may have initially process rental applications and fill out lease forms. You should require any locator services you use to furnish you their privacy policies. Thank You,

Burton Properties - Angie Bien ________ Owner or Management Company

Signature:______________________________________

Date:__________________________________________

BURTON PROPERTIES
N12099 STATE ROAD 79, DOWNING WI 54734 OFFICE-760-203-2260 FAX-760-203-0170

TENANT SELECTION CRITERIA
Burton Properties will not have any restriction based on race, color, religion, sex, familial status, marital status, disability, national origin, or ancestry, that restriction violates state and federal fair housing laws. The following is a list of items that Burton Properties will be checking on your application: 1, 2 Employment - we want to know how long you have been at your current job and the amount you receive per hour or month. And that you are in good standing with your employer Rental Reference - we want to know if you paid your rent on time and if you were a good tenant. If we find that you owe your landlord money we will ask for a statement that you have made arrangements to pay them. If we find that you have been or are being evicted, you will be may be denied. Criminal Background check - we want to know if you have any felony or misdemeanors. If you have a felony or misdemeanor, you will be asked to explain what happen and you can be refused for tenancy. If you are found to have more than one DWI or DUI, drug related charges, sexual assault charges or any type of abuse charge you may be refused for tenancy

3.

By signing this acknowledgement indicated that you have had the opportunity to review the landlord's tenant selection criteria. The tenant selection criteria may include factors such as criminal history, credit history, current income and rental history. If you do not meet the selection criteria, or if you provide inaccurate or incomplete information, your application may be rejected. The application fee is non-refundable. If you have any questions regarding this selection plan please feel free to contact me at 715-643-6404 or 715-6432024.

Angie Bien Office Manager

Signature:_________________________________ Date:____________________________________


				
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