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TENANT'S PERSONAL AND CREDIT INFORMAITON

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                     TENANT’S PERSONAL AND CREDIT INFORMATION
           (In the event of co-tenants, other than spouses, use separate sheet for each tenant)
                                                                         Social Security No.
Name                                                     DOB             Drivers License No.
Co-Tenant                                                DOB             Social Security No.
Present Address                                                          Drivers License No.
City/State/Zip                                    Res. Phone                        Bus. Phone
Occupants                                                              Animals?

Car Make                     Year                Model                Color                Lic. No.
                                                 Occupation
                                    Present Occupation           Prior Occupation      Co-Tenant’s Occupation
Occupation
Employer
Self-employed, d.b.a.
Business Address
Business Phone
Type of Business
Position held
Name & Title of Superior
How long
Monthly Gross Income
                                         Landlord Information
                                       Present                                       Previous
Name
Phone Number
Monthly Rent
Date of Occupancy
                                                 References
Bank Reference                               Address                                  Phone
     Credit           Account No.         Address          Highest Amount       Purpose of      Account Open
   Reference                                                   Owed               Credit        or Date Closed


 Personal Reference          Address                 Phone               Length of              Occupation
                                                                       Acquaintance


  Nearest Relative           Address                 Phone                    City              Relationship


Have you ever filed a petition of bankruptcy? _________Have you ever been evicted from any tenancy or had
an eviction notice served on you?________ Have you ever willfully and intentionally refused to pay any rent
when due?___________ I DECLARE THAT THE FOREGOING IS TRUE AND CORRECT, AUTHORIZED IT’S
VERIFIATION AND THE OBTAINING OF A CREDIT REPORT. I agree that the landlord may terminate any
agreement entered into a reliance on any misstatement made above. DATE: ________________________

______________________________________Applicant_____________________________________Applicant
Application may be mailed to 1415 Camelback Lane, B105, Boise, ID 83702; Faxed to 208-389-9132 or email
to diazandpartners@fiberpipe.net. By submitting this form in any method, you are authorizing the credit
check and any other necessary checks needed to verify the information given.

				
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posted:9/30/2011
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