Rental Agreement – Central Plains Homes

How did you hear about us ??

Local Ad
Website
Social Media
Friend

Name *

First

Last

Home Phone *

Work Phone *

Email *

Social Security # *

Drivers License # / State issued *

Present Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long at Present Address *

If renting Appartment Name/Location *

Landlord/Manager Name *

Phone# *

Why are you leaving ? *

Current rent $$ *

Previous Address *

Address Line 1

Address Line 2

City

State

Zip Code

How Long at Previous address *

If Rented - Appartment Name/Location *

Landlord/Manager Name *

Phone *

Why did you leave ? *

Rent Payment $$ *

Present Employer *

Position *

How Long *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Gross Income before deductions *

Other Income / Source *

Former Employer *

Position *

How long *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Why did you leave ? *

Credit References

This may include store cards, rental stores, car loans, small loans, etc...

Bank Name *

Account Numbers *

Branch *

Checkboxes *

Checking
Savings
Loans

City *

State *

Approximent Balance $ *

How Long *

Other Credit Active ref *

Account # *

Exp. date *

Type of Account *

Credit Limit $$ *

How Long *

Are all payables current ? *

Other Active Credit Ref. *

Account # *

How Long *

Have you ever been evicted ? *

Have you ever had a foreclosure or repossession *

Date *

If yes , please explain *

Have you ever filed for bankruptcy ? *

If Yes *

Chapter 7
Chapter 13

Explain *

Have you ever been covicted of a crime, other than a traffic violation *

If yes , explain *

Personal References

List 3 persons, Other than your relatives, that we can contact to verify your character

Name *

Relationship *

Phone *

Name *

Relationship *

Phone *

Name *

Relationship *

Phone *

Emergency

In an emergency you may contact – List 2 with the nearest relative first

Name *

Relationship *

Phone *

Name *

Relationship *

Phone *

Other Information

Other persons, including children who will live in the dwelling unit

Name *

*Pets

*NOTE: No pets are allowed at any time on the premises without prior management consent and payment of fees. NO EXCEPTIONS

Name | Type | Weight *

Date of desired occupancy *

Anticipated length of stay *

Do you own the following *

Vacuum Cleaner
Lawn Mower
Musical Instrument
Waterbed

Are you a smoker ? *

Make - Model - Color - Year - Plate # - State *

List all motor vehicles, including recreational to be kept at the property.

Monthly Car Payment $$ *

Terms

A non-refundable application fee of $-- and a reservation/deposit fee of $--- are required for processing this application and is being paid herewith. The undersigned expressly agrees that if this application is approved applicant herewith agrees to rent this property. Applicant further agrees that is applicant is accepted by management and then decides not to move into the premises, then all monies paid herewith shall be retained as liquidated damages since other prospective tenants may have been turned away and it may be necessary for management to re-advertise the property and evaluate other applicants. Processing of application shall be as timely as possible, and the results may be delivered via phone, fax or mail. Once approved, applicant agrees to pay the balance of the funds and complete the paperwork within 48 hours, otherwise management will assume that applicant has decided to forfeit the reservation/ deposit money payment made herewith and will begin re-marketing the property. If applicant is not approved, all monies given herewith, less application fee shown above shall be returned to the applicant. A Photostatic copy of my driver’s license or picture ID card, social security card, latest pay check stubs(s) and last years W-2(s) or copy of last years income tax return are attached to the application( ) or will be provided( ). I declare that the application is complete, true and correct and I herewith give my permission for anyone contacted to release the credit or personal information of the undersigned applicant to management of their authorized agents, at any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended. I further authorize management and their authorized agents to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employees and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement entered into with management. Any false information will constitute ground for rejection of the application, or management may at any time immediately terminate any agreement entered into in reliance upon misinformation given on this application.

Applicant Signature *

Date *

Document Upload

Please upload a copy of you drivers license, Social Security Card, Latest Pay stub and last years W-2 or tax return to our secure sever.

Drivers License / ID *

Social Security Card *

Pay Stub *

W-2 or last years tax return *

Phone