Leasing Application – Apartments

"*" indicates required fields

Renter #1 Information

D.O.B.

Renter #2 Information

D.O.B.

Current information

Address*

Occupants

Pets

Renter #1 Employment

Address*
Dates employed*
To

Renter #2 Employment

Address
Dates employed
To

Miscellaneous

Preferred move-in date*
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 renter #2 ever had an eviction filed or left owing money to an owner/landlord?
Has renter #2 applied for residency in the past two years, but did not move in?
Has renter #2 ever rented with Bielinski?
Has renter #2 ever had an adjudication withheld or been convicted of a crime?

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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