RENTAL APPLICATION
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REQUIRED TO SUBMIT: |
Application is not complete until page 4 is signed. Unless this |
(Cash, MO, CC) |
application is initialed on each page it will not be processed. (If |
Application (Non-Refundable) |
more than two persons are applying, use additional applications.) |
Fee $ |
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Deposit to Hold $ |
PROPERTY ADDRESS |
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Amt. Received $ |
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CITY, STATE, ZIP |
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MOVE-IN DATE |
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(NON-REFUNDABLE) APPLICATION FEE $ |
RENT $ |
SECURITY DEPOSIT |
$ |
PET DEPOSIT $ |
(NON-REFUNDABLE) PROCESSING FEE $ |
KEY DEPOSIT $ |
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CLEANING FEE $ |
OTHER $ |
EVIDENCE BY: CASH |
CHECK |
CASHIER'S CHECK |
MONEY ORDER |
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
APPLICANT:
HOME PHONE # |
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OTHER PHONE |
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EMAIL |
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SSN# |
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DL# |
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STATE |
BIRTH DATE |
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CURRENT ADDRESS: |
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CITY, STATE, ZIP |
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LANDLORD NAME / MORTGAGE HOLDER: |
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PAYMENT: |
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PHONE # |
HOW LONG? |
(PLEASE CHECK ONE) |
OWNED OR |
RENT |
REASON FOR LEAVING |
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PRIOR STREET ADDRESS: |
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CITY, STATE, ZIP |
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LANDLORD NAME / MORTGAGE HOLDER: |
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PHONE # |
HOW LONG? |
(PLEASE CHECK ONE) |
OWNED OR |
RENT |
REASON FOR LEAVING |
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CURRENT EMPLOYER: |
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HOW LONG? |
EMPLOYED AS |
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ADDRESS: |
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CITY, STATE, ZIP |
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PHONE # |
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FAX# |
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Rental Application Rev. 11/09 |
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Page 1 of 4 |
Applicants Initials: [ |
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Las Vegas Housing Experts LLC 5550 Painted Mirage #320 Las Vegas, NV 89149 |
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Phone: (702)818-1700 |
Fax: (702)818-1701 |
Michael Parks |
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Untitled |
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Produced with ZipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 |
www.zipLogix.com |
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SALARY: $ |
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PER/MO SUPERVISOR: |
OTHER INCOME: SOURCE |
AMOUNT: $ |
PRIOR EMPLOYER (IF LESS THAN 3 YEARS): |
PHONE # |
HOW LONG? |
EMPLOYED AS |
SALARY: $ |
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PER/MO SUPERVISOR: |
CREDIT REFERENCES: |
BANK |
ACCT.# |
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ADDRESS |
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
CO-APPLICANT:
SSN # |
DL# |
STATE |
BIRTH DATE |
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PHONE # |
EMAIL |
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CURRENT ADDRESS: |
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CITY, STATE, ZIP |
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LANDLORD NAME / MORTGAGE HOLDER: |
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PAYMENT: |
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PHONE # |
HOW LONG? |
(PLEASE CHECK ONE) |
OWNED OR |
RENT |
PRIOR STREET ADDRESS: |
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CITY, STATE, ZIP |
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LANDLORD NAME / MORTGAGE HOLDER: |
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PHONE # |
HOW LONG? |
(PLEASE CHECK ONE) |
OWNED OR |
RENT |
REASON FOR LEAVING |
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CURRENT EMPLOYER: |
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HOW LONG? |
EMPLOYED AS |
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ADDRESS: |
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CITY, STATE, ZIP |
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PHONE # |
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FAX# |
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SALARY: $ |
PER/MO SUPERVISOR: |
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OTHER INCOME: SOURCE |
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AMOUNT: $ |
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PRIOR EMPLOYER (IF LESS THAN 3 YEARS): |
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PHONE # |
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HOW LONG? |
EMPLOYED AS |
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SALARY: $ |
PER/MO SUPERVISOR: |
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Rental Application Rev. 11/09 |
Page 2 of 4 |
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Applicants Initials: [ |
] [ |
] |
Produced with ZipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 |
www.zipLogix.com |
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Untitled |
CREDIT REFERENCES: BANK |
ACCT.# |
ADDRESS
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AUTOMOBILES: |
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MAKE |
MODEL |
LIC# |
STATE |
YR |
COLOR |
MAKE |
MODEL |
LIC# |
STATE |
YR |
COLOR |
MAKE |
MODEL |
LIC# |
STATE |
YR |
COLOR |
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IN ADDITION TO APPLICANT(S), OTHER PERSONS TO BE AT PREMISES: |
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NAME |
RELATIONSHIP |
AGE |
OCCUPATION |
PETS? (Y/N) |
HOW MANY? Cats |
Dogs |
Other |
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Name |
Cat or Dog? |
Breed |
Weight Spayed or Neutered? |
If Other, please explain:
HAS ANY APPLICANT EVER FILED BANKRUPTCY? |
GIVE DETAILS |
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HAS ANY APPLICANT EVER BEEN EVICTED? |
EXPLAIN |
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HAS ANY APPLICANT EVER WILLFULLY REFUSED TO PAY RENT WHEN DUE? |
EXPLAIN |
HAS ANY APPLICANT OR OCCUPANT EVER BEEN CONVICTED OF A GROSS MISDEMEANOR OR FELONY? |
YES OR NO |
IF YES PLEASE EXPLAIN |
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Rental Application Rev. 11/09 |
Page 3 of 4 |
Applicants Initials: [ |
] [ |
] |
Produced with ZipForm® by zipLogix |
18070 Fifteen Mile Road, Fraser, Michigan 48026 |
www.zipLogix.com |
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Untitled |
HOW LONG DOES APPLICANT PLAN TO LIVE HERE? |
DOES APPLICANT PLAN TO USE LIQUID FILLED |
FURNITURE? |
TYPE |
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DOES ANYONE IN THE HOUSEHOLD SMOKE? Y/N |
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APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY: |
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RELATIONSHIP: |
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PHONE # |
CO-APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY: |
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RELATIONSHIP: |
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PHONE # |
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DISCLOSURE
PLEASE READ CAREFULLY BEFORE SIGNING
1.APPLICANT UNDERSTANDS THAT
IS THE LEASING AGENT AND REPRESENTATIVE FOR THE LANDLORD OF THE PREMISES LOCATED AT AT A
2.APPLICANT DECLARES THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT, AND APPLICANT AUTHORIZES AN EMPLOYMENT CHECK, CRIMINAL RECORDS CHECK, CREDIT CHECK, VERIFICATION OF REFERENCES AND CURRENT AND PREVIOUS LANDLORDS.
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3. |
APPLICANT HEREBY PAYS $ |
AS A NON-REFUNDABLE APPLICATION FEE AND |
$ |
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AS HOLDING DEPOSIT. IF APPLICANT IS DECLINED, HOLDING DEPOSIT SHALL BE |
REFUNDED WITHIN |
BUSINESS DAYS. IF, AFTER APPROVAL, APPLICANT DECIDES NOT TO FULFILL THIS |
AGREEMENT BY COMPLETING LEASE AND PAYING FIRST MONTHS RENT AND REMAINING SECURITY DEPOSIT, HOLDING DEPOSIT SHALL BE RETAINED BY LANDLORD TO COVER ADMINISTRATIVE EXPENSES.
4.APPLICANT AGREES TO EXECUTE A RENTAL AGREEMENT BEFORE POSSESSION IS GIVEN AND TO
PAY THE RENT AND SECURITY DEPOSIT WITHIN |
BUSINESS DAYS AFTER BEING NOTIFIED OF |
ACCEPTANCE OF THIS APPLICANT. |
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5.LANDLORD AND AGENT WILL NOT BE BOUND BY ANY REPRESENTATIONS, AGREEMENTS OR PROMISES, WRITTEN OR ORAL, MADE BY LANDLORD OR AGENT UNLESS CONTAINED IN THE RENTAL AGREEMENT SIGNED BY LANDLORD OR LANDLORD'S AGENT.
6.APPLICANT DOES HEREBY RELEASE LANDLORD, AGENT AND THIS COMPANY FROM ANY AND ALL DAMAGES OR LIABILITIES WHICH MIGHT RESULT FROM THE ABOVE INFORMATION. APPLICANT RELEASES PRESENT LANDLORD AND ALL PREVIOUS LANDLORDS FROM ANY AND ALL LIABILITY FOR ANY DAMAGE OR INJURY WHATSOEVER CAUSED BY PROVIDING INFORMATION TO LANDLORD OR AGENT REGARDING APPLICANT.
7.APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT A FALSE STATEMENT MADE HEREIN IS GROUNDS FOR DENIAL OF RENTAL TO APPLICANT. ANY STATEMENT HEREIN MAY BE CONSTRUED AS A CONDITION PRECEDENT TO ANY BINDING RENTAL AGREEMENT OR CONTRACT BETWEEN APPLICANT AND LANDLORD.
8.APPROVAL FOR RESIDENCY IS MADE WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, OR HANDICAP.
9.APPLICANT UNDERSTANDS THAT APPLICANT ACQUIRES NO RIGHTS TO PREMISES UNTIL EXECUTION OF A RENTAL AGREEMENT IN THE FORM SUBMITTED AND DEPOSIT OF RENT AND SECURITY DESCRIBED ABOVE.
SIGNATURE OF APPLICANT |
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TIME |
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SIGNATURE OF CO-APPLICANT |
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TIME |
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OFFICE USE ONLY: |
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REFERRAL COMPANY Las Vegas Housing Expert MLS # |
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DATE PAID |
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AGENT: Michael Parks |
P.I.D. # 208441 |
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LICENSE # |
1000997 |
THE GREATER LAS VEGAS ASSOCIATION OF REALTORS® PROVIDES THIS FORM FOR MEMBERS ONLY AND IS NO |
WAY DEEMED RESPONSIBLE FOR INFORMATION PROVIDED THEREIN. |
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Rental Application Rev. 11/09 |
Page 4 of 4 |
Applicants Initials: [ |
] [ |
] |
Produced with ZipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 |
www.zipLogix.com |
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Untitled |
