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Property Applying For: *

Desired Move-in Date: *

Name: *

First

Last

Phone Number: *

Email: *

Present Address: *

Address, City, State, Zip

Social Security Number: *

Driver's License Number: *

Date of Birth: *

Employer: *

How Long: *

Length of time you have worked for listed employer.

Monthly Income: *

Current Rent: *

Who will occupy premises: *

Adults
Kids
Dogs
Cats

Number of Adults

Selected Value: 0

Number of Kids

Selected Value: 0

Number of Pets

Selected Value: 0

Landlord History: Address *

Landlord History: Date Occupied *

Landlord History: Rent *

Landlord Name *

First

Last

Landlord Phone Number *

30 Day Notice Required *

Yes
No
I do not currently live here

Reason for Leaving *

Landlord History: Address

Landlord History: Date Occupied

Landlord History: Rent

Landlord Name

First

Last

Landlord Phone Number

30 Day Notice Required

Yes
No
I do not currently live here

Consent to Contact Landlords *

Yes
No

Landlord Information may be submitted to Landlords listed.

Credit Report *

Agree
Disagree

I (We) certify that all statements made on this application are true and complete and are for the purpose of evaluating my rental credit worthiness. I (We) understand that you will retain this application whether or not it is approved. I (We) authorize you, your agent or manager, to make whatever credit, criminal history and employment history inquiries are deemed necessary in connection with this application. Genesee Landlords Association is providing a service to its members and may provide the credit report on you. This report is only to be used in the selection process by said Landlord. I (We) hereby give permission for the Genesee Landlords Association to obtain this credit report and furnish it to the Landlord indicated below who hereby agrees to use this report only for the above stated purposes.

Applicant Signature *

Date *

Application Payment