Date ________ ____ PHONE _______________________________________

Desired date of occupancy _______________________________

Rental unit applied for ________________________________

Name ______________________________________ __ Married __ Divorced __Separated __ Single

Date of Birth ____________________ Social Security No. __________________________

Spouse's Name or Co-Applicant ____________________________________

Date of Birth ___________________ Social Security No. __________________________

No. of people who will occupy: Adults (over age 18)____ Children (thru age 18) ______

Ages of children who will occupy:__________ Description of Pets: __________________________

In case of emergency, notify: _____________________________________________________________

Present Landlord _______________________ Phone ______________________To: ______________

Previous Landlord______________________ Phone ______________________To: _______________

Previous Landlord ______________________ Phone ______________________ To: _______________

A. Employed by ___________________________ Phone _______________Length of Employment _______

Address ______________________________ Position_______________ Approx. Wkly Income _______

Address ______________________________ Position________________ Approx. Wkly Income ______

Address ______________________________ Account No. _____________________________________

Credit References:

Character References:

Number of Vehicles (Incl. Co. Cars)___________________ Driver's Loc. No. ____________ State________

Make ___________________________________________ Year _________ License ___________________

Make ___________________________________________ Year _________ License ___________________

Have your ever been convicted of any crime other than a minor traffic offense: ___ Yes ____ No

If Yes, Please explain _______________________________________________________________________

Have you ever filed bankruptcy: ____ Yes ____ No

Have you ever had any judgments or other legal proceedings against you? _____ Yes _____ No

Have you ever been served an eviction notice or been asked to vacate a property you were renting? __ No __ Yes

If Yes, Please explain _______________________________________________________________________

Have you ever willfully or intentionally refused to pay rent when due? ____ Yes ___ No

If Yes, Please explain _______________________________________________________________________

Do you know of anything which may interrupt your income or ability to pay rent? ___ Yes ___ No

If Yes, Please explain _______________________________________________________________________

This application must be signed by all adults who will occupy the apartment before it can be considered by Landlord.

I/We have never been, nor am I/We now being evicted from any rental unit nor have I/We ever broken, or in any manner failed to honor a lease or rental agreement.

I/We understand that providing false or incomplete information on this application shall be grounds for immediate denial or eviction.

I/We am depositing along with this application the sum of $ ______, which leaves a balance due on my Security Deposit in the amount of $________.

I/We am deposit along with this application and the above deposit, the sum of Twenty- Five Dollars ($25.00) as a non-refundable application fee.

If this application is accepted, I/We agree to:

I/We understand that if this application is accepted and I/We decide not to lease the residence, all moneys deposited shall be forfeited to Landlord as liquidated damages.

I/We further understand that if this applications is not accepted, any deposits shall be returned.

I/We have re-examined the information which I/We have provided on this application, and I/We declare that the information is true and complete, and I/We hereby authorize you to conduct an employment and credit check and to verify our references.

By signing, the applicant(s) recognizes that an investigative report may be prepared whereby information is obtained through interview. This inquiry includes information as to your character, general reputation, credit, and mode of living. The application may be disapproved as a result of; any misrepresentation or insufficient information as a result of an incomplete application.

Applicant __________________________________ Date ____________ Time________________

Co-Applicant _______________________________ Date ____________ Time_______________

BY MY SIGNATURE BELOW I AUTHORIZE MARKET PROPERTIES, INC., the leasing agent and representative for the owner/landlord, to obtain a Consumer Credit Report and/or a Background Report on me. This authorization is valid for purposes of verifying information given pursuant to past residency, employment history, credit history, criminal history, leasing, rental, business negotiation, or any other lawful purpose covered under the Fair Credit Reporting Act (FCRA).

The background check may contain information available in the Public Domain but may not include interviews with persons other than previous employers and Landlords or their agents.

By my signature below, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts and agencies, military services and persons to release all information they may have about me. This authorization shall be valid in original or copy form.

Applicant's Name ____________________________ Co-Applicant's Name _______________________

Social Security Number _______________________ Social Security Number _____________________

Date of Birth ________________________________ Date of Birth ______________________________

____________________________________________ __________________________________________

Signature Date Signature Date

NOTE: This form has been placed in the public domain and may be copied as needed.