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Download Application - APPLICATION FOR RENTAL

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					                                            HUGHES REAL ESTATE, Inc.
                             P.O. Box 3956, Champaign, IL. 61826 ** Voice: 217-359-0203 Fax : 217-359-9114
                                              Visit us on the Web at : www.hughesre.com
                                   Office Hours: 8am – 12noon & 1pm – 5pm Monday thru Friday
                           * WE HAVE ADDED A AFTER HOURS DROP BOX FOR YOUR CONVENIENCE! *


Address of Property Applying For:_______________________________________________________

                                        APPLICATION FOR RENTAL
   (Please print clearly – Complete ALL Sections – Please return to agent with   Application Fee - $30 non-refundable)
APPLICANT’S PERSONAL INFORMATION: (All Blanks must be filled)

Applicant’s Last Name (include all names you use):___________________________________________________________
First Name:       ____________________________             Do you have internet access? ___ yes, ___ no
Middle:           ____________________________             If yes, please list e-mail address:
Birthdate (mm/dd/yyyy): _____________________              __________________________________________________
Driver’s License # / State: ___________________________________
Social Security Number : ___________________________________
Any additional name you have used for any purpose : _________________________________________________________
Current Street Address: ______________________________________ City/State/Zip: ______________________________

ADDITIONAL APPLICANT or ADULT OCCUPANT PERSONAL INFORMATION:
                                                       Other Occupants (i.e. children, long-term guest, etc.)
Last Name:        _____________________________        Name / (m/f) / age: _____________________________
First:            _____________________________        Name / (m/f) / age: _____________________________
Middle:           _____________________________        Name / (m/f) / age: _____________________________
Birthday (mm/dd/yyyy): ______________________          Name / (m/f) / age: _____________________________
Relation to Applicant:    ______________________
Social Security Number: ______________________
Current Street Address: ______________________________________ City/State/Zip: ______________________________

CURRENT INFORMATION
Best Phone Number to reach regarding any questions we have on this application:____________________________

Address of present landlord/owner/mortgage company: ________________________________________________________
Landlord’s phone: _____________________________           Monthly Rental Amount: _____________________________
Reason for moving:____________________________________________________________________________________
Is your rent/mtg current? _________________________       Number of late payments: ____________________________
Damage Deposit Amount currently held by landlord? __________      Original Damage Deposit Amount: ______________

PREFERRED METHOD OF RENTAL PAYMENT:
Check _____ Money-Order _____ Other ______________________________________________________

PREFERRED RENTAL DUE DATE:
Old Fashion Method – Monthly _____             Pay Day – Bi-Weekly _____ (bi-weekly requires monthly 10% sur-charge)
Do you currently own any real estate? _____________________________
Type of Property Owned: ________________________________________________________________________

How long do you plan to live in the next rental home that meets your needs? ________________________________
Would you like to purchase a home within the next 2 years? If so, what size of property would you like to buy? __________
_________________________________________ What price range are you interested in? ___________________________
Would you be interested in our Rent-To-Own (RTO) program to help you find and buy your first or next home? __________


CHECK THE FOLLOWING ITEMS THAT YOU OWN:
Automobile _____           Furniture _____ Appliances (i.e., Refrigerator or Stove) _________________________________
Vacuum _____               Snow Shovel _____          Lawn Mower _____
*Please note: Residents who handle minor maintenance and repairs on the property and pass property inspections are eligible
to receive money at closing to help purchase a future home (that’s part of our Rent-To-Own RTO program).

CHECK ALL PROFESSIONAL LEVEL SKILLS POSSESSED:
Electrical _____ Painting _____ Plumbing _____ Roofing _____          Appliance Repair _____
Air Conditioning _____ Heating _____ Carpentry _____


What kind of animals do you have? _______________________________________________________________________
Do you own a waterbed?: ___________________________________________
Do you smoke? Yes _____           No _____


Misc. Question for both the Applicant , Additional Applicant& Additional Adult Occupant:
Have you ever had a rental damage deposit not returned? ________________
Have you ever broken a lease? __________ Have you ever refused to pay rent for any reason? ________________________
Explain: _____________________________________________________________________________________________
How many evictions have been filed against you or your additional applicant?______________________________________
Have you ever been asked to leave a rental unit for any reason other than not paying rent? ______________________,
Explain ______________________________________________________________________________________________
Have you ever been convicted of a felony? __________ Do you have any history of drug use or offenses? _______________
Will you give us permission to do a criminal background check? _________________
Will this criminal background check show anything you wish to explain ?_________________________________________
____________________________________________________________________________________________________
Will you give us permission to do a credit background check? ___________________
Will this credit check show anything you wish to explain: _________________________________________________
____________________________________________________________________________________________________
Is there anything to prevent you from placing utilities in your name? _____________________________________________
Do you currently have any utilities in your name? ____________________________________________________________
Do you currently have phone service in your name?____________________________
How long have you been in this area? __________ Length of expected stay: _______________________________________
Do you know of anything or any reason, which may interrupt your ability to pay rent? _______________________________
____________________________________________________________________________________________________
Do you have renter’s Insurance? ___________
                                      RESIDENCE HISTORY (Previous 5 Years):
Street Address: _____________________________________________________
City: _______________________ State: ____________ Zip:________________________
Dates lived at this address? ________________________________
Own _____          Rent ______      Occupy (i.e. live w/ relative & not pay rent) _____
Landlord?______________________________________ Previous Landlord’s Phone? ______________________________
Monthly Rental Amount: ______________________ Reason for moving: _________________________________________
Number of Late Payments? _________________ Was your Damage Deposit Returned? _____________________________

Street Address: _____________________________________________________
City: _______________________ State: ____________ Zip:________________________
Dates lived at this address? ________________________________
Own _____          Rent ______      Occupy (i.e. live w/ relative & not pay rent) _____
Landlord?______________________________________ Previous Landlord’s Phone? ______________________________
Monthly Rental Amount: ______________________ Reason for moving: _________________________________________
Number of Late Payments? _________________ Was your Damage Deposit Returned? _____________________________

Street Address: _____________________________________________________
City: _______________________ State: ____________ Zip:________________________
Dates lived at this address? ________________________________
Own _____          Rent ______      Occupy (i.e. live w/ relative & not pay rent) _____
Landlord?______________________________________ Previous Landlord’s Phone? ______________________________
Monthly Rental Amount: ______________________ Reason for moving: _________________________________________
Number of Late Payments? _________________ Was your Damage Deposit Returned? _____________________________

                                                 INCOME HISTORY
APPLICANT’S CURRENT EMPLOYMENT STATUS:
Full-time _____ Part-time (less than 32 hrs)______ Student _____ Retired ______
Self-employed _____      Unemployed _____          Other ______________________

PRIMARY SOURCE OF EMPLOYMENT:
Applicant employed by: __________________________________           Supervisor’s name: __________________________
Average Weekly hours: __________________ How long at the place of employment : ______________________________
Address: _____________________________________________________________________________________________
City: ________________________________________ State: ______________ Zip: ________________________________
Phone: _______________________________________
Position: _____________________________________            Salary: ____________________________________________
Please indicate Weekly, Bi-Weekly, Monthly, or annual Average Take home: ______________________________________

ADDITIONAL EMPLOYMENT or Additional Applicant’s Employment:
Applicant employed by: __________________________________           Supervisor’s name: __________________________
Average Weekly hours: __________________ How long at the place of employment : ______________________________
Address: _____________________________________________________________________________________________
City: ________________________________________ State: ______________ Zip: ________________________________
Phone: _______________________________________
Position: _____________________________________            Salary: ____________________________________________
Please indicate Weekly, Bi-Weekly, Monthly, or annual Average Take home: ______________________________________
                                  ADDITIONAL INCOME / PAYMENT INFORMATION
To avoid the possibility of late charges, would you authorize that we arrange payment through your employer thru automatic
payroll deduction? ________________________
Employer payroll contact and phone: ______________________________________________________________________

In the event of some emergency that would prevent you from paying your rent when due, is there a relative, person or agency
that could assist you with rental payments?
1st Emergency Contact: ______________________________________________                Relationship: _________________
Address: _____________________________________________________________________________________________
Phone Number(s) ______________________________________________________________________________________

2nd Emergency Contact: ______________________________________________    Relationship: _________________
Address: _____________________________________________________________________________________________
Phone Number(s) ______________________________________________________________________________________




ADDITIONAL INCOME: (optional)
 If there are additional, verifiable sources of income you would like considered, please list income source (i.e., self-
employment, social security, benefit payments, child support, etc.), and requested information below regarding each.

Applicant may be required to produce additional documentation or provide and sign release statements.
Child support, alimony, or separate maintenance need NOT be disclosed unless you desire this additional income to be
considered for qualification.

Additional Source:_____________________________________________ Amount $_______________ Per ____________
Contact Person: ________________________________________________ Phone: ________________________________
How long have you been receiving income from this source? ___________________________
How long do you expect this income to continue: ____________________________________
Is there any reason it would stop? _________________________________________________
Additional Source:_____________________________________________ Amount $_______________ Per ____________
Contact Person: ________________________________________________ Phone: ________________________________
How long have you been receiving income from this source? ___________________________
How long do you expect this income to continue: ____________________________________
Is there any reason it would stop? _________________________________________________


                                           ASSET / CREDITS / LOANS
Number of vehicles on property? _________________      Valid registration & inspection? ________________________
Do you have any commercial vehicles, ____________      RV, campers, boats or motorcycles? ____________________
Vehicle #1 make/model/color: ___________________________________________________________________________
Plate number _____________________________________ State _________________
Finance/leased through _____________________________ Contact and phone number ____________________________
Acct. # __________________________________________ Monthly payment ___________________________________
Vehicle #2 make/model/color: ___________________________________________________________________________
Plate number _____________________________________ State _________________
Finance/leased through _____________________________ Contact and phone number ____________________________
Acct. # __________________________________________ Monthly payment ___________________________________
                                      CREDIT CARDS, LOANS, & BANKS
                             (including bank, department store, gas cards, student loans)
Creditor : __________________________________________________________________
Address : _____________________________________________________________ Phone : ________________________
Acct. # : ______________________________________________________ Amount Owed : _________________________
Monthly Payment : _____________________________________________

Creditor #2 : __________________________________________________________________
Address : _____________________________________________________________ Phone : ________________________
Acct. # : ______________________________________________________ Amount Owed : _________________________
Monthly Payment : _____________________________________________

Check and list amounts of any other current monthly expenses:
Hospital payment __________        Health Insurance __________    Auto Insurance __________
Renter’s Insurance __________      Child care __________ Tuition ___________
Cable TV __________       Other _________________________         Other ______________________________________

Name of Bank: ___________________________________ Branch Address: ______________________________________
Acct.# : _________________________________________ Checking and/or Savings _______________________________
How long account active, Checking __________ Savings __________
Average monthly balance, Checking __________ Savings __________
Phone : ______________________________________________________

                                               REFERENCES
Character/Personal reference:
Name _______________________________________________________
Address _____________________________________________________
City _____________________________ State _____ Zip ______________
Relationship ___________________________ How Long? ____________
Phone _______________________________________________________

Professional reference (i.e. attorney, accountant):
Name _______________________________________________________
Address _____________________________________________________
City _____________________________ State _____ Zip ______________
Relationship ___________________________ How Long? ____________
Phone _______________________________________________________

Name of nearest Living Relative:
Name _______________________________________________________
Address _____________________________________________________
City _____________________________ State _____ Zip ______________
Relationship ___________________________ How Long? ____________
Phone _______________________________________________________
Name of Doctor or Health Care Provider:
Name _______________________________________________________
Address _____________________________________________________
City _____________________________ State _____ Zip ______________
Relationship ___________________________ How Long? ____________
Phone _______________________________________________________

Do you give owner or manager permission to contact references listed above for rental consideration or for collection
purposes should they be deemed necessary? _________________________

If Management has a question regarding this application, please furnish the best contact phone number:
Day Phone/Contact person: _____________________________ Night Phone/Contact person: ________________________

In case of emergency, notify: ____________________________________________________
Day emergency contact ________________________________________________________
Relationship: ___________________________ Phone: _______________________________
Night emergency contact _______________________________________________________
Relationship: ___________________________ Phone: _______________________________

A completed application requires submission of the following, which will be photocopied and attached to this application:
___ Driver’s License
___ 2 weeks of most current pay stubs of each income source listed


A fee of $30 is charged on all rental applications for purpose of verifying the information furnished on
the application. By signing below, applicant hereby represents all information on this application is true,
complete, and hereby authorizes verification of information, references, and credit history from
applicants credit sources, credit bureaus, current and previous landlords, employers and references.
This fee is non-refundable. If your application is approved, you will be required to pay a damage
deposit that will be equal to the 1st months rent to hold any property.

Applicant acknowledges this application will become part of the lease agreement when approved. If any
information is found to be incorrect, the application will be rejected and any subsequent rental
agreement becomes void. False and misleading statements will be sufficient reason for immediate
eviction and loss of damage deposit.

Final Note: Our Company offers a $50 rental referral fee to residents who recommend friends, relatives,
or co-workers to us and they meet our minimum criteria and decide to rent from us. Please give the
name of a friend, relative or co-worker along with a phone number and we will contact them to see if
they too would like to apply and rent one of our homes.
The following person(s) may be interested in renting a home:

_________________________________________ Phone ____________________________
_________________________________________ Phone ____________________________
PREVIOUS LANDLORD QUESTIONERE                                         (APPLICANT : DO NOT FILL OUT THIS SECITON)

APPLICANT’S NAME: _________________________________________________

RENTAL ADDRESS: ___________________________________________________

LANDLORD NAME : __________________________________________________

LANDLORD ADDRESS: _______________________________________________

RESIDENCY TIME:             FROM __________________          TO       ____________________

RENTAL AMOUNT:              $____________________ PER___________

CIRCLE THE CORRECT RESPONSE:

Any NSF’s                                  YES               NO                If yes, how many?__________________
Late Payments                              YES               NO                If yes, how many?__________________
Was Proper Notice Given                    YES               NO
Housekeeping Satisfactory                  YES               NO
Noise Complaints                           YES               NO                If yes, how many?__________________
Excessive Damage                           YES               NO
Would you Renew the lease                  YES               NO
Are you evicting them?                     YES               NO
How many people occupied apartment/house? __________________


Person verifying information:      ________________________________________
                                   Position: ________________________________________
                                   Telephone:       ________________________________________


Any other Coments?_______________________________________________________________________________________
______________________________________________________________________________________________________


     SIGNATURE BELOW INDICATES AUTHORATION TO RELEASE INFORMATION:
                NOTE: APPLICATION WILL NOT BE CONSIDERED COMPLETE UNTIL SIGNED.

Applicant’s Signature: _____________________________________      Date ______________________
Co-Applicant’s Signature:     _____________________________________       Date ______________________

Thank you for applying for our home rental, and, if you are accepted, we look forward to providing you not just a home, but
also helping you with all your housing related needs. You will be notified within 24 hours as to acceptance or rejection of
your application.

                                      NOTICE:
ALL DAMAGE DEPOSIT MONIES PAID ARE NOT REFUNDALBE UNTIL THE COMPLEATION OF A LEASE