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RENTAL APPLICATION Date Office Use Applicants Name

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					PMC PROPERTIES, LLC
P. O. BOX 10676
TERRE HAUTE, IN 47801



                                        RENTAL APPLICATION


Date:________________                                        Office Use: _____________________


Applicants Name     _________________________________________________________

Date of Birth       __________________________________________________________

Social Security #    ________________________

Driver’s License    _____________________State _____Issue Date ________Expire Date _________

Home Phone #        ________________________ Work Phone #________________________

Resident History (Three year history or two most recent residences)
Present Address       _________________________     Previous Address _________________________
                       ________________________                      ____________________________
Dates at this Address from _____________________   Dates at this Address from_______________________
Mortgage/landlord _________________________        Mortgage/ landlord ___________________________
Landlord phone #__________________________         Landlord phone #____________________________
Landlord fax #____________________________        Landlord fax #______________________________
Monthly Payment __________________________         Monthly Payment ___________________________
Reason for moving _________________________        Reason for moving__________________________
__________________________________               ______________________________________

EMPLOYMENT HISTORY

Present Employer: _________________    Previous Employer: ________________
________________________________       _______________________________
Position: ____________________________    Position: _________________________
How Long? __________________________      How Long? ____________________
Business Address: ___________________     Business Address: __________________
___________________________________       ________________________________
Gross Monthly Salary__________________    Gross Monthly Salary______________
Supervisors Name____________________      Supervisors Name_________________
Employer’s Phone____________________     Employer’s Phone_________________
Employer’s Fax #____________________     Employer’s Fax #_________________
Additional Monthly Income_____________   Additional Monthly Income__________

If Full Time Students:
Mother’s Name_______________________              Father’s Name___________________
Address_____________________________              Address________________________
____________________________________              _______________________________
Phone #_____________________________              Phone #_________________________
PMC PROPERTIES, LLC
P. O. BOX 10676
TERRE HAUTE, IN 47801



BANK INFORMATION
Checking Account #_______________________ Savings Account #______________________
Bank Name         _____________________ Phone Number        _____________________
City, State       _____________________ Fax Number          _____________________

VEHICLE INFORMATION
Year& make____________________ Color________ License #____________ State________
Year& make____________________ Color________ License #_____________State________

PERSONAL INFORMATION (Contact Name of person over age of 18 who will not be living with you)
Name           ___________________________Name_____________________________
Address        ___________________________Address___________________________
________________________________________ ________________________________
Phone #__________________________________ Phone#__________________________
Relationship______________________________ Relationship______________________

PET INFORMATION (May be restricted by community)
Will you or do you have a pet? ____________If Yes, how many? _____________________
Type: ____________ Breed______________ Mature Height_______ Mature Weight_______
Type: ____________ Breed______________ Mature Height_______ Mature Weight_______

OTHER INFORMATIION
Have you ever been evicted from any leased premises? ______ If Yes, explain:____________


Have you or any other resident or occupants declared bankruptcy? __Will you have a waterbed __
Have you or any other resident or occupants been convicted of a Felony? ___________
Have you or any other resident or occupants received deferred adjudication for a Felony? ____

The undersigned warrants and represents all statements true and correct and hereby authorizes verification of the information through all available
means including but not limited to, obtaining a consumer credit report and other reports as maintained by City, County, State and Federal law
Enforcement Agencies, present and or past employers including but not limited to and or past salary verification and present and or past residences.
Applicant agrees to furnish additional credit references upon request.
Owner/owner’s agent reserves the right to regularly furnish information to consumer reporting agencies and other rental housing owners about
performance of lease obligations by our residents. Such information which may be reported at any time, includes both favorable and unfavorable
information regarding resident’s compliance with the lease, rules and financial obligations.
APPICATION FEE (NON-REFUNDABLE)
Applicant submits herewith a non-refundable payment in the amount of $_________for the credit check and processing charge for the contemplated
rental. Such sum is not a rental payment or security deposit. Payment should be made in check, money order or cashiers check. Owner will notify
Applicant(s) of the approval or denial within seven (7) days after the date the application is received in the leasing office.
APPLICATION DEPOSIT (MAY OR MAY NOT BE REFUNDABLE)
Applicant submits herewith a separate payment in the amount of $________ as Application Deposit in connection with the application of residency.
If the lease was not signed at the time of application, applicant(s) must sign the lease within (3) days of the date of the personal or telephone
notification of the approval of the application or within five (5) working days after owner mails notification of approval of the applicant(s). All
required security deposits must be paid in full at the time of the lease signing. If Applicant(s) has already signed the lease agreement, when the
owner approves the application, a representative will notify applicant(s) of the approval, sign the lease contract, and then credit the application
deposit of all applicants towards the required security deposit.

Applicant’s Signature__________________________________Date_____________________
I UNDERSTAND THAT THIS IS AN APPLICATION AND DOE NOT CONSTITUTE A LEASE AGREEMENT IN WHOLE OR IN PART.
APPLICANT’(S) MUST NOT ASSUME APPROVAL OF THE APPLICATION UNTIL APPLICANT (S) HAS RECEIVED NOTIFICATION OF
APPROVAL FROM OWNER IN PERSON BY TELEPHONE OR BY MAIL
PMC PROPERTIES, LLC
P. O. BOX 10676
TERRE HAUTE, IN 47801



    REQUEST FOR BANK & OR EMPLOYMENT VERIFICATION
                  PMC PROPERTIES, LLC
THIS RELEASE FORM MUST ACCOMPANY APPLICATION.
Release: I hereby authorize the release of the requested information.

_________________________________              ______________________
Applicant      print                          Social Security #
_________________________________              ______________________
Applicant      sign                            Date
_____________________________________________________________________

Employment History: (Employer must complete)
Present Employer: ______________________How Long: ____________________
Position:           ______________________Monthly Salary: ________________
Would you rehire: ______________________
Name & title of person supplying request information Name of firm/organization
                                                     _____________________
_______________________                              _____________________
Signature                                             Date


Verification of Rent: (Landlord must complete)
Length of Tenancy:                   ___________
Was rent paid on time: (yes or no) ___________
Number of late payments:             ___________
Does this person currently have an outstanding balance due? __________
Name & title of person supplying request information     Name of firm/organization
                                                          _____________________
_______________________                                  _____________________
Signature                                                 Date


Bank Information: (Bank must complete)
Open Account (yes or no) when: _________________
Satisfactory Account (yes or no)
Name & Title of person supplying request information      Name of firm/organization
                                                          _____________________
_______________________                                   _____________________
Signature                                                 Date




                            PLEASE RETURN TO PMC PROPERTIES, LLC
                                       P. O. BOX 10676
                                    TERRE HAUTE, IN 47801

				
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