Lofts Form - Small Nation: Helping Small Towns and Businesses Thrive

Application Date*

MM/DD/YYYY

Applicant Information

Legal Name of Applicant*

First Middle Last

Social Security Number*

Email*

Current Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Date of Birth*

MM/DD/YYYY

Occupation - Full or Part Time

Yearly Income*

Home Phone

Cell Phone

Employer

Employer Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

How Long on Job

Employer Contact Number

In Case of Emergency, Notify

Current Landlord

Landlord Phone

Years with Landlord

Lease Expiration Date

Current Rent

Auto License Plate

Pets? If Yes, What Kind

How Many and Size

Co-Applicant Information

Name

First Middle Last

Email

Current Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Date of Birth

Occupation

Yearly Income

Home Phone

Cell Phone

Employer

Employer Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

How Long on Job

Employer Contact Number

In Case of Emergency, Notify

Current Landlord

Landlord Phone

Years With Landlord

Lease Expiration Date

Current Rent

Auto License Plate

Pets? If Yes, What Kind

How Many and Size

Applicants References (Other Than Relatives)

Reference 1's Name

First Last

Reference 1's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Reference 1's Phone

Reference 2's Name

First Last

Reference 2's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Reference 2's Phone

Co-Applicant's References

Reference 1's Name

First Last

Reference 1's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Reference 1's Phone

Reference 2's Name

First Last

Reference 2's Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Reference 2's Phone

Applicant's Bank References

Checking

Savings

Credit Cards/Other

Co-Applicant's Bank References

Checking

Savings

Credit Cards/Other

Your Credit History

Have you declared bankruptcy in the past seven (7) years?*

Yes
No

Have you ever been evicted from a rental residence?*

Yes
No

Have you had two or more late rental payments in the past year?*

Yes
No

Additional Sources of Income

If you have other sources of income for us to consider, please list income, source, and person (banker, employer, etc.) who we may contact. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

ADDITIONAL INFORMATION: Please give us any additional information that might help the owner/management to evaluate your application. If you have a specific property in mind, please list that below as well.

Notices
I/We hereby warrant that all representations set forth above are true. To verify the above statements, I/We direct those persons named in this application to ask questions about me or us. I/We waive all rights of actions for consequences as a result of such information. I/We agree and authorize and give permission to the management company , owner or servicing company to perform a credit on me/us. I/We agree to pay $30 for the credit check as permitted by state law.

If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living as permitted by state law.

Name of Applicant

Date

Name of Co-Applicant

Date

Authorization
Release of Information:
I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner, manager, brokerage, finder, agent or leasing company

Name

Signature

Date

Name

Signature

Date

Leasing Application

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