| Please print and fill out this form, then FAX it to 971-270-2777 |
| Management Company | Complex Name | Contact | Telephone | |
| Move In Date | Unit # | Monthly Rent $ | Lease | Referred by |
APPLICANT INFORMATION |
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| APPLICANT LAST NAME FIRST NAME MIDDLE | D.O.B. | Social Sec. # | Driver's Lic. # |
| ROOM MATE(S) NAME(S) | |||
CURRENT RESIDENCE |
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| CURRENT ADDRESS Apt. City State Zip | Rent [ ] Own [ ] |
Move in date Move out date |
Telephone |
| LANDLORD/Mortgage Co. Name City
State Zip Landlord
Day Phone Landlord
Evening Phone |
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PREVIOUS RESIDENCE |
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| PREVIOUS ADDRESS Apt. City State Zip | Rent [ ] Own [ ] |
Move in date Move out date |
Telephone |
| LANDLORD/Mortgage Co. Name City State Zip Landlord Day Phone Landlord Evening Phone | |||
| REASON FOR VACATING: | LIST ANY ROOMMATES YOU HAD: | ||
EMPLOYMENT |
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| APPLICANT CURRENT EMPLOYER | POSITION | TELEPHONE | SUPERVISOR NAME | SALARY/MONTH | DATE OF HIRE: MO/YR |
| ADDITIONAL SOURCES OF INCOME PER MONTH (LIST
ANY INCOME TO BE INCLUDED FOR QUALIFICATIONS): $ /MONTH FROM: PHONE: |
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ADDITIONAL INFORMATION |
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| APPLICANT Bank Name | Branch | Telephone | Checking Account # | Savings # |
LIST ALL VEHICLES TO BE PARKED ON SITE |
OTHER OCCUPANTS |
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| MAKE | ODL | YEAR | COLOR | LICENSE# | STATE | OCCUPANT NAME | D.O.B. |
| OCCUPANT NAME | D.O.B. | ||||||
| List other vehicles to be parked on site: | |||||||
| Have you or any person who will occupy the unit ever been convicted, plead guilty, no-contest or currently have pending charges for any felony or misdemeanor No[ ] Yes [ ] Date: Describe Offense: | Have you ever been evicted? NO [ ] YES [ ] |
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| EMERGENCY CONTACT | RELATIONSHIP | ADDRESS | TELEPHONE |
APPLICANT SCREENING CHARGE $ |
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| I certify that the above information is
correct and complete and hereby authorize you to do a credit check and
make any inquiries you feel necessary to evaluate my tenancy and credit
standing. I understand that giving incomplete or false information is
grounds for rejection of this application. If any information supplied
on this application is later found to be false, this is grounds for termination
of tenancy. Owner/Agent has charged a screening charge as set forth above.
Applicant screening entails the checking of the applicant’s credit,
rental history, employment history, public records and other criteria
for residency. The applicant has the right to dispute the accuracy of
any information provided to the owner/agent by the screening service or
credit reporting agency. Applicant’s copy of this signed application
shall be the receipt for the screening charge. The screening service is
Pacific Screening Inc., P.O. Box 25582, Portland, OR 97298 (503) 297-1941.
If the applicant is approved, applicants will have _________ hours from
the time of notification to either execute a rental agreement and make
all deposits required thereunder or make a deposit to execute a rental
agreement which will provide for the forfeiture of the deposit if applicants
fail to execute the rental agreement. If applicants fail to timely take
the steps required above, they will be deemed to have refused the unit
and the next application for the unit will be processed. Owner / Agent
shall have no liability to applicant until such time as a rental agreement
is signed by both parties. Applicant acknowledges receipt of a copy of
the Criteria for Residency. The information contained in this application
is true and complete. Signed (Applicant) |