APPLICATION TO RENT SCREENING AUTHORIZATION by smx43008

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									                                                                            APPLICATION TO RENT & SCREENING AUTHORIZATION                                                                          EVERGREEN
                                                                                                                                                                                                    SCREENING
PROPERTY: ______________________________________                                              LEASING AGENT: ___________________                                   UNIT #: ____________

MOVE-IN DATE: __________ RENT: $ ______________                                             CO-SIGNER APP: ______ (Y/N)                               LEASE TERM: _______________

APPLICANT NAME – LAST                                         FIRST                   MI                  DRIVERS LICENSE #                                   SOC. SEC. #                DATE OF BIRTH

_______________________ ______________                                              ______           ______________________                           ___________________         _________________
SPOUSE:                                        or COSIGNER FOR:
_____________________                                 ______________                ______           ______________________                           ___________________         _________________
Names & Dates of Birth of Other Occupants: __________________________________________________________________________________
Do You Have : Renter's Insurance: YES                                 NO                                                     PETS: YES NO             If so, list type   _________________________
    Have You or any other
     proposed occupant :                         been convicted of a crime:YES NO           had a judgment entered against you: YES NO                been evicted: YES NO       filed for bankruptcy: YES NO

                                                  CURRENT ADDRESS                                                            PRIOR ADDRESS                                        PRIOR ADDRESS

                          Street
                          City
    RESIDENCE HISTORY




                          State
                          Zip Code                    Phone
                          Alternate Contact Phone
                          Rent or Own
                          Monthly Payment
                          From (Mo/Yr) / To (Mo/Yr):

                          Name of Complex or Owner:
                          Mgr's Ph. No.:
                                       APPLICANT'S PRESENT OCCUPATION                                             APPLICANT'S PRIOR OCCUPATION                              SPOUSE CURRENT OCCUPATION

                          Occupation

                          Employer
                          Bus. Address
    EMPLOYMENT




                          City, St., Zip
                          Bus. Phone       (      )
                          Type of Business
                          Position / Rank
                          Supervisor / C.O.
                          From (Mo/Yr) / To (Mo/Yr):
                          Monthly Salary

                          Other Source of Income: ______________________________________________                               Monthly Amount: $ __________________
 VEHICLE & LOAN




                          Auto #1 (Make & Model)            License Plate                   State                         Car Payment Made to (Co. name and address)                        Monthly Pymt
  REFERENCES




                          Auto #2 (Make & Model)            License Plate                   State                         Car Payment Made to (Co. name and address)                        Monthly Pymt

                          Insurance Company                                         Agent                                                                   Phone No.


                                       FINANCIAL INSTITUTION                                             ACCOUNT NUMBER                                                   BRANCH, CITY, STATE
BANK
INFO




                          Name of APPLICANT'S Nearest Relative                      Relationship                    Address, City, State, Zip                                    Phone
    CONTACT INFORMATION




                          Name of SPOUSE'S Nearest Relative                         Relationship                    Address, City, State, Zip                                    Phone

                          Emergency Contact                                         Relationship                    Address, City, State, Zip                                    Phone

                          Personal Reference                                        Relationship                    Address, City, State, Zip                                    Phone

                          Applicant's home E-mail Address                                                           Applicant's work E-mail Address




                            Rev 04-09                                                                               1 of 2
Page 2 of Applicant:_____________________________________Applicant:______________________________________________




In consideration of Landlord reserving the premises for me pending screening results, I hereby agree to pay a holding fee of $_______________
(check/money order #____________________) which will be applied to my account upon my taking possession of the premises. Any holding fee paid by the
applicant prior to taking possession of the premises will be forfeited as liquidated damages in the event my application to rent is unconditionally approved or
approved with conditions that I agree to, either verbally or in writing, and I fail to take possession of the premises within seven days of the move-in date noted
above. In the event my application is not accepted, the holding fee will be returned to me. I understand that I acquire no rights to the premises until I sign a
Standard Form Lease Agreement in the form submitted to me and pay all holding fees, rent and other charges due at move in.
I/we certify the facts set forth in this application are true and complete and hereby authorize Landlord and Evergreen Screening (ES) to perform a complete
investigation of all the information on this application and to obtain information as ES deems necessary to verify all information on this application. I authorize
ES to release any or all of the information on this application to prospective landlords for rental purposes. I UNDERSTAND AND AGREE THAT ANY
OMISSION OR MISREPRESENTATION ON THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR DENIAL OF MY APPLICATION TO RENT AND/OR
TERMINATION OF MY TENANCY UPON THREE DAYS NOTICE BY LANDLORD.
In compliance with the Fair Credit Reporting Act, this is to inform you that a credit investigation using the statements made on this Application to
Rent/Screening Authorization form will be performed, including an investigative consumer report regarding your character, criminal record and general
reputation, rental history, credit history, employment status and mode of living (for applicant and any other occupant's including minor individuals). You have
the right to dispute the completeness and accuracy of the scope of the investigative consumer report.
I HEREBY AGREE TO PAY A NON-REFUNDABLE SCREENING FEE OF $______________ (check/money order #___________________). Per RCW
62A.3-515, NSF checks will be subject to a handling fee of $25.00. Additional fees and penalties will apply if NSF checks and handling fees are not paid
within 15 days of postmarked notice.

 Landlord:                                                                        Applicant:
                Property Name                                                                          Signature                              Date
      By:                                                                         Applicant:
                    Signature                             Date                                         Spouse's Signature                     Date

It is our policy to abide by the Washington State Law against discrimination and the Federal Fair Housing Act, which prohibit discrimination in housing on the
                                   p y                        y                                                  g      yp          p             g
basis of race, color, creed, sex, physical or mental disability, familial status, marital status, or national origin. Any person or persons meeting our minimum
qualifications of tenancy may rent from our apartments regardless of race, color, creed, sex, physical or mental disability, familial status, marital status, or
national origin. If you believe that you have been discriminated against based on one or more of these factors, you should bring the matter to the attention of
the management or ownership of the apartments or contact the Washington State Human Rights Commission as soon as possible.




        Rev 04-09                                                             2 of 2

								
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