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| PERSONAL INFORMATION | |||
| LAST NAME |
FIRST NAME | MIDDLE NAME | SOCIAL SECURITY # |
| DATE OF BIRTH |
DRIVER'S LICENSE# | HOME PHONE | WORK PHONE |
| PRESENT ADDRESS |
CITY | STATE / ZIP | |
| HOW LONG HAVE YOU LIVED THERE? |
OWNER or MANAGER | PHONE | |
| PREVIOUS ADDRESS |
CITY | STATE / ZIP | |
| DATES YOU RESIDED THERE |
OWNER or MANAGER | PHONE | |
| HAVE YOU EVER BEEN EVICTED? EXPLAIN |
HAVE YOU EVER FILED FOR BANKRUPTCY? WHEN? | ||
| OCCUPANTS | |||
| PROPOSED OCCUPANTS OTHER THEN YOURSELF 1). |
3). |
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| 2). |
4). |
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| DO YOU OWN ANY PETS? HOW MANY? WHAT TYPE? |
WILL YOU HAVE ANY LIQUID FILLED FURNITURE? WHAT TYPE? | ||
| VEHICLES | |||
| VEHICLE MAKE |
MODEL | YEAR | LICENSE PLATE # |
| MOTORCYCLES / BOATS / TRAILERS |
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| REFERENCES | |||
| PERSONAL REFERENCE |
PHONE | YEARS KNOWN | |
| PERSONAL REFERENCE |
PHONE | YEARS KNOWN | |
| PERSONAL REFERENCE |
PHONE | YEARS KNOWN | |
| EMERGENCY CONTACT | |||
| NAME |
PHONE | ADDRESS | RELATIONSHIP |
| EMPLOYMENT INFORMATION | |||
| EMPLOYER |
PHONE | ADDRESS | |
| POSITION |
SUPERVISOR | LENGTH OF EMPLOYMENT | |
| PREVIOUS EMPLOYER |
PHONE | ADDRESS | |
| POSITION |
SUPERVISOR | LENGTH OF EMPLOYMENT | |
| CURRENT GROSS INCOME |
OTHER INCOME | ASSETS | |
| CREDIT INFORMATION | |||
| NAME OF BANK |
BRANCH OR ADDRESS | ACCOUNT# | CHECKING OR SAVINGS |
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| MONTHLY BILLS | |||
| NAME OF CREDITOR |
ADDRESS | PHONE NUMBER | MONTHLY PAYMENT |
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| LIST ANY OTHER DEBTS |
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| Applicant testifies all of the above is true and correct and hereby authorizes verification including, but not limited to the obtaining of a credit report, criminal background check, verification of employment and current and past residence. Applicant further agrees to furnish additional credit references if requested. The undersigned makes application to rent housing accomodations from Safire Limited, LLC. If accepted and upon signing a rental agreement, Applicant agrees to pay all sums due, including required security deposits prior to occupancy. APPLICANT__________________________________________DATE________ APPLICANT__________________________________________DATE________
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