Rent on Nance Road Application

Please complete the application. All required fields are indicated as such. Driver’s license and social security number may be requested. If any of the information entered into this form is found to be untrue the landlord reserves the right to evict the tenant.

Desired date of occupancy(Required)

The rent shall be $800.00 per month, payable in advance.

The following deposit are required:

Security deposit of $800.00

The deposit will be returned to the Applicant if the Premises are not rented to the Applicant. The total amount of $800.00 shall be due upon signature of the lease.

The Applicant understands that the Landlord may perform a credit check to verify the Applicant’s credit references and credit history in connection with the processing of this Rental Application.

Name(Required)

First Last

Number of occupants(Required)

Number of children(Required)

Any Pets?(Required)

None

Dog

Cat

Other

Pet details

Please indicate what type of pets you have including the breed and size or long hair or short hair.

Current Address

Current Address(Required)

Current City(Required)

Current State(Required)

Current Zip Code(Required)

How long at this address?(Required)

Best phone number to reach you(Required)

Current landlord's name(Required)

Current landlord's phone number(Required)

Current monthly rent payment(Required)

Prior Address

Prior City(Required)

Prior State(Required)

Prior Zip(Required)

Prior Landlord's Name(Required)

Prior Landlord's Phone(Required)

Prior Rent Payment(Required)

Number of vehicles(Required)

Sources of Income

Please round or tell us in general. We may ask for proof of income. Not all fields require input.

Wages

Salary

Commission

Tips

Government Assistance

Child Support/Alimony

Other (amount)

Please indicate the source

Current Employer

Employer(Required)

Position(Required)

How Long?(Required)

Supervisor(Required)

Business Phone(Required)

Annual Income(Required)

Previous Employer

Employer(Required)

Position(Required)

How Long?(Required)

Supervisor(Required)

Business Phone(Required)

Annual Income(Required)

Have you ever been evicted from a rental premises?(Required)

Yes

Please explain

Have you ever willfully and intentionally refused to pay rent when due?(Required)

Yes

Please explain

Are there any circumstances which may interrupt your income or ability to pay rent?(Required)

Yes

Please explain

Have you ever been convicted of a felony?(Required)

Yes

Please explain

Please enter your full name(Required)

This constitutes a digital signature.

IT IS AGAINST THE LAW TO DISCRIMINATE AGAINST PROSPECTIVE TENANTS ON THE BASIS OF RACE, RELIGION, NATIONAL ORIGIN, AGE, DISABILITY OR FAMILY STATUS. LOCAL OR STATE LAWS MAY INCLUDE ADDITIONAL CLASSES WHICH ARE PROTECTED FROM DISCRIMINATION IN HOUSING.

The information provided by the prospective tenant(s) may be used by Kathy J. Hall and/or Keith R. Hall (Landlords) to determine whether to accept this Application. Upon written request within 60 days, the Landlords will disclose to the Applicant in writing the nature and scope of any investigation the Landlords has requested, and will, if the Application is refused, state in writing the reason for said refusal.

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