RENTAL APPLICATION AND CREDIT REPORT

RENTAL APPLICATION AND CREDIT REPORT

MARCEL BARTLEY, RE/MAX COAST TO COAST

Office 603-431-1111 ext 3820   Fax 603-431-5779

Rental Address___________________________________________________________________

Town___________________________________________________________________________

Monthly Rent____________________________________________­­___­­­­_____________________

Desired Date of Occupancy__________________________________________________________

APPLICANT INFORMATION

Last Name___________________________ First Name_________________________ MI____

Date of Birth_______________________   Social Security #_________________________

Drivers License #_________________________ Issuing State_____________________

Phone Numbers:            Work_________________________________________________

                                    Home_________________________________________________

                                    Cell__________________________________________________

Email__________________________________________________________________

Present Address___________________________________________________________

Town__________________________ State______________ Zip__________________

How long at this address__________________________________ Rent______________

Present Landlord/Manager_______________________________Phone________________

Reason for Moving________________________________________________________

Previous Address_________________________________________________________

Town______________________ State__________________ Zip__________________

How long at this address______________________________ Rent________________

Previous Landlord/Manager_______________________________Phone______________

Reason for Moving_________________________________________________________

Present Employer_________________________________________________________

Supervisor______________________________Phone____________________________

Monthly Income_________________________ Other Income_____________________

List all others who will live in the premises, other than yourself.____________________

_______________________________________________________________________

List all Pets/Animals:   Breed___________________________________________________

Weight/Size__________________________________Age____________________________

Vehicle(s):

Make____________________Model______________Year________Plate #_____________State______

Make____________________Model______________Year________Plate #_____________State______

PERSONAL REFERENCES

Name________________________Address__________________________Phone__________________

Name________________________Address__________________________Phone__________________

Name________________________Address__________________________Phone__________________

CONTACT IN EMERGENCY

Name__________________________________ Relationship______________________

Address______________________________________ Phone_____________________

Have you ever filed bankruptcy?                   Y   N                

Have you ever been evicted?                         Y   N

Have you ever been convicted of a crime?    Y  N

I HEREBY APPLY TO MARCEL BARTLEY, RE/MAX COAST TO COAST PROPERTIES FOR A CREDIT CHECK.  THE BROKERS MANAGERS AND ASSIGNED CREDIT BUREAU MAY VERIFY MY PAST AND PRESENT EMPLOYMENT EARNINGS, BANK ACCOUNTS, AND ANY OTHER ASSET BALANCES NEEDED TO VERIFY MY CREDIT CHECK.  I FURTHER AUTHORIZE THE VERIFICATION OF PAST AND PRESENT LOANS AND LANDLORD REFERENCES.  IT IS UNDERSTOOD THAT A PHOTO COPY OR FAX OF THIS FORM WILL ALSO SERVE AS AUTHORIZATION.  THE UNDERSIGNED WARRANTS AND REPRESENTS THAT ALL STATEMENTS HEREIN ARE TRUE AND UNDERSTANDS THAT ANY FALSE STATEMENTS WILL BE CONSIDERED GROUNDS TO REFUSE THE APPLICATION, OR TO TERMINATE ANY RENTAL AGREEMENT.

Signature___________________________________________Date______________________________