Apartment Leasing Application - Bielinski Management

Renter #1 Information

First*

Int.

Last*

D.O.B*

Drivers License #*

State*

SSN*

Renter #2 Information

First

Int.

Last

D.O.B.

Drivers License #

State

SSN

Current Information

Present Address*

City*

State*

Zip Code *

Mobile Phone

Email Address*

Occupants

First

Last

Age

Relationship

First

Last

Age

Relationship

Pets

Type

Breed

Weight

Age

Renter #1 Employment

Present Employer*

City*

State*

Zip Code*

Phone*

Ext.

Position*

Dates Employed*

Income*

per

Manager*

Renter #2 Employment

Present Employer

City

State

Zip Code

Phone

Ext.

Position

Dates Employed

Income

per

Manager

Miscellaneous

Community of Interest*

Preferred Move-In Date*

LEASING CONSULTANT'S NAME*

Other sources of income you wish us to consider.

Have you ever had an eviction filed or left owing money to an owner/landlord?*

Have you applied for residency in the past two years, but did not move in?*

Have you ever rented with Bielinski?*

Have you ever had an adjudication withheld or been convicted of a crime?*

Has your spouse ever had an eviction filed or left owing money to an owner/landlord?

Has your spouse applied for residency in the past two years, but did not move in?

Has your spouse ever rented with Bielinski?

Has your spouse ever had an adjudication withheld or been convicted of a crime?

The leasing consultant promised me the following items which are key in my deciding to apply for this apartment:

How did you hear about us?

Applicant(s) agree to pay for a non-refundable application processing fee.

AUTHORIZATION OF RELEASE OF INFORMATION: Applicant(s) represents that all of the above information and statements on the application for rental are true and complete, and hereby authorizes an investigative consumer report including, but not limited to, residential history (rental and mortgage), employment history, criminal history records, court records, and credit records. The results of the investigation can be made available to you upon written request within a reasonable length of time. Applicant acknowledges that false or omitted information herein may constitute grounds for rejection of this application, termination of right of occupancy, and/or forfeiture of fees or deposits and may constitute a criminal offense under the laws of this State.

RESERVATION FEE AGREEMENT: Applicant has paid a "reservation fee" of $100.00 in consideration of taking the dwelling unit off the market while considering the approval of this application. If applicant(s) is approved and the contemplated lease is entered into, then on the day of move in the reservation fee will be credited towards payment of the security deposit. If the applicant(s) is approved but fails to promptly enter into the contemplated lease, the reservation fee will be retained by owner as liquidated damages. The reservation fee will only be refunded if the applicant(s) cancel this application with written notice within 24 hours, or if application is not approved; refunds will be sent via mail within 30 days of cancellation. This application is preliminary only and does not obligate landlord or landlord's agent to execute a lease or deliver possession of the proposed premises. No oral agreements have been made. The Landlord has disclosed that there are no uncorrected code violations.

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Leasing Application – Apartments