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Applicant name |
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|
Primary phone number |
mobile work home |
|
Secondary phone number |
mobile work home |
|
Primary email |
work home |
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Secondary email |
work home |
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Present address, city, state / province, zip, country |
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|
How long at this address |
Less 6 Months 6-12 months 13-23 months 24 or more months |
Prior address, city, state /
province, zip, country |
only if less than 2 years at present address |
Emergency contact,
relationship, and phone |
|
|
Social security number |
international applicants include "NA" and
place credit identification in 'other notes' below |
Driver's license number and
state or country |
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Date of birth |
format: mm/dd/yyyy |
|
Total number of occupants |
|
|
Property desired |
|
|
Quoted or published rent amount |
$ |
|
Quoted or published available date |
format: mm/dd/yyyy |
Current landlord or mortgage
company and phone |
|
|
Current monthly rent |
$ |
Employer, job title, and
length of employment |
|
|
Supervisor and phone |
|
|
Average gross monthly income |
$ |
Have you ever been
convicted of a felony? |
no
yes - explain
|
Have you ever refused to
pay rent or been evicted? |
no
yes - explain
|
Will there be any
pets on the premises? |
no
yes - explain
pet policy: no dogs; no reptiles; one cat permitted with $150 non-refundable pet deposit; two cats permitted with $200 non-refundable pet deposit; one bird permitted with $150 non-refundable pet deposit; other pets -
email first |
|
Vehicle year, make, and model |
|
Bank name and location
as shown on check |
|
|
Bank routing number |
located between the symbols on your check. Located at the bottom of the check, it must be 9 digits, be sure to enter preceding zeros if applicable; for additional details, see check illustration at the bottom of this page |
|
Bank account number |
usually located before the  symbol, exact location and number of digits varies by bank, be sure to enter preceding zeros if applicable; for additional details, see check illustration at the bottom of this page |
ACH RT number
(if applicable) |
ACH RT
some checks have a separate 9-digit ACH RT number printed on the check
|
|
Major credit card |
Visa
Mastercard
Expiration Date
Your credit card will not be charged at this time. The information is taken as a credit reference and as a secondary source of payment as explained in the lease terms and conditions |
|
Other notes |
|
Acknowledgement and
Electronic signature |
By typing my name
below, I am electronically signing a draft from an account that I am authorized to withdraw funds from. I understand that fraudulent submission of any account data will be prosecuted to the fullest extent of the law. I am consenting to a credit and background investigation. I have reviewed and agree to the
terms and conditions of the lease, the
e-payment policy, and
Protecting your family from lead in your home. My bank account will be
debited $50 per applicant. If my application is denied, there will be no further debits. If application is approved, a deposit in the amount of one's month rent plus applicable pet deposit will be debited. This deposit is refundable at the termination of the lease provided all terms and conditions of the lease are fulfilled. If I decide to not accept the apartment and my application is approved, my deposit will be forfeited. My rent will be automatically deducted from this account on the 1st of each calendar month. I agree to notify Florida Land Group LLC with any account number changes. Date
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