RENTAL/CREDIT APPLICATION SHORT FORM
DATE: ________________________ INTERVIEWED BY: LAST NAME OF APPLICANT: ___________________________________
__________________________________________________________
FIRST NAME OF APPLICANT: __________________________________________________________ MIDDLE NAME OF APPLICANT: _________________________________________________________ SOCIAL SECURITY NUMBER OF APPLICANT: ______________________________________________ BIRTH DATE OF APPLICANT: ____________________________ WHAT STATE: _________________ DRIVER'S LICENSE NUMBER: __________________________ CURRENT ADDRESS: CITY: STATE: _______________________
__________________________________________________ APT # ________ STATE: _________ ZIP CODE: _________________
____________________________
TELEPHONE NUMBER: (_______)_______________
CELL NUMBER (________)_________________
PRIOR ADDRESS: ____________________________________________________________________ CITY: ____________________________ STATE: _________ ZIP CODE: _________________
TELEPHONE NUMBER: (_______)_______________ HOW MANY IN YOUR FAMILY?
CELL NUMBER (________)_________________
ADULTS: ____________ CHILDREN: _______________ PETS: ____
NAME OF EMPLOYER: __________________________________________________________________ ADDRESS OF EMPLOYER: _______________________________________________________________ CITY: ____________________________ STATE: ___________ ZIP CODE: ___________________ SUPERVISOR: ____________________________
TELEPHONE NUMBER: (________)______________ POSITION: ___________________
START DATE: ____________ ENDING DATE: _______________ IF YES WHEN: _______________
HAVE YOU EVER FILED FOR BANKRUPTCY: _____ YES _____ NO
WHAT STATE: ____________________ BANKRUPTCY NUMBER: ________________________________ HAVE YOU EVER BEEN EVICTED FROM A PROPERTY: _____ YES _____ NO WHERE: ________________ IF YES WHEN: _______
HAVE YOU INTENTIONALLY NOT PAID YOUR RENT: ____ YES ____ NO
I/WE, THE UNDERSIGNED, UNDERSTAND THAT K-LAK CORPORATION IS THE LEASING AGENT AND REPRESENTATIVE FOR THE LANDLORD/OWNER. I UNDERSTAND THAT I AM RESPONSIBLE TO PAY A $25.00 RENTAL/CREDIT APPLICATION FEE. I/WE DECLARE THE FOREGOING INFORMATION IS TRUE AND CORRECT, AND I/WE HEREBY AUTHORIZE YOU TO CONDUCT AN EMPLOYMENT, DRIVER, CRIMINAL RECORDS AND CREDIT REPORT FROM ALL BUREAUS AND TO VERIFY OUR REFERENCES. __________________________________________________ APPLICANT'S SIGNATURE DATE ___________________________________________ CO-APPLICANT'S SIGNATURE DATE