Rental App 2009

RENTAL APPLICATION ADDRESS OF RENTAL PROPERTY: _____________________________________________________________________ PLEASE NOTE: A separate application is required for each applicant over the age of 18 (excluding dependent children) who will reside at the property. This is to guarantee compliance with the state and Federal Fair Housing Acts. THE FOLLOWING TWO OPTIONS* ARE MADE AVAILABLE TO ALL APPLICANTS: FIRST OPTION: Applicants desiring to live together as a single housekeeping unit may elect to financially qualify for tenancy as a group, in which case Landlord has the right to immediately terminate the rental contract when any one member of that group vacates the property. SECOND OPTION: Each legal entity may elect to financially qualify for tenancy individually, in which case the occupant may continue to lease the property if one or more of the other parties to the rental contract vacate the property for any reason. *PLEASE NOTE: All applicants desiring to live together must choose the same option I elect the first option. I elect the second option. Desired Length of Occupancy: ______________ Desired Move-In Date: ______________ APPLICANTS WILL NOT BE ACCEPTED ON "A FIRST-COME, FIRST-SERVED BASIS." LANDLORD WILL ASSIST ALL PERSONS WITHOUT REGARD TO RACE, COLOR, CREED, SEX, RELIGION, NATIONAL ORIGIN, FAMILIAL STATUS, MARITAL STATUS, HANDICAP, OR ANCESTRY. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

PLEASE PRINT LEGIBLY OR TYPE Applicant's Name _____________________________________________________ Driver's Lic # ______________________ Soc Sec # ________________________ Home telephone # _____________________________ Work Telephone #_______________________________ Mobile Telephone # __________________________ LIST YOUR LAST FOUR YEARS RESIDENCE HISTORY & AT LEAST YOUR LAST TWO ADDRESSES Current Address ________________________________________________________ City____________________________ State____________ Zip____________ Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.) ______________________________________________________________ How long at present address?_________________________________ Occupancy dates______________ Why moving _______________________________________ Landlord's name ______________________________________________________________________________ Phone #____________________________________ Current monthly rent or mortgage payment?______________________________________________ If you own your current residence, please supply name and address of Mortgage Co__________________________________________________________________________________________________________________________ Loan# ________________________________________________________________________________Phone#___________________________________________ Former address _________________________________________________________City____________________________ State____________ Zip_____________ Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.)______________________________________________________________ How long at former address? _________________________________ Occupancy dates ______________ Why moved_ ______________________________________ Former Landlord's Name _________________________________________________________________ Phone # __________________________________________ Former address _________________________________________________________City____________________________ State ____________ Zip ____________ Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.)______________________________________________________________ How long at former address?____________________________________ Occupancy dates ____________ Why moved ___________________________________ ___ Former Landlord's name __________________________________________________________________ Phone # _________________________________________ Former address _________________________________________________________City____________________________ State ____________ Zip ____________ Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.)______________________________________________________________ How long at former address?____________________________________ Occupancy dates ____________ Why moved ___________________________________ ___ Former Landlord's name __________________________________________________________________ Phone # _________________________________________ LIST YOUR EMPLOYMENT HISTORY FOR THE LAST FOUR YEARS (List military rank if applicable) Current Employer ___________________________________________________________________ Dates: _________________________ Phone # __________ ___ Address _______________________________________________________________ City ____________________________ State ___________ Zip _____________ Position / Job description __________________________________________________________________________________Monthly gross pay $________________ Mo take-home________ Superior's name & position ________________________________________________________________________Phone # ______________ List any additional monthly income (child support, SS, etc.)_______________________________________________________________________________________ Former Employer ___________________________________________________________________ Dates: _________________________ Phone # __________ ___ Address _______________________________________________________________ City ____________________________ State ___________ Zip _____________ Position / Job description __________________________________________________________________________________Monthly gross pay $________________ Mo take-home________ Superior's name & position ________________________________________________________________________Phone # ______________ Former Employer ___________________________________________________________________ Dates: _________________________ Phone # __________ ___ Address _______________________________________________________________ City ____________________________ State ___________ Zip _____________ Position / Job description __________________________________________________________________________________Monthly gross pay $________________ Mo take-home________ Superior's name & position ________________________________________________________________________Phone # ______________ Mail to: Scott Britton, Agent, P.O. Box 16204, Jackson, MS 39236-6204 APPLICATIONS WILL NOT BE PROCESSED WITHOUT THE $20.00 APPLICATION FEE!

LIST NEAREST RELATIVES Name Address Phone Relationship 1. _____________________________________________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________________________________________ LIST ALL VEHICLES OWNED Make/Model/Year License No./State Vehicle 1. _____________________________________________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________________________________________ 3. _____________________________________________________________________________________________________________________________________ LIST ALL PETS WHICH YOUR DESIRE TO HAVE LIVE ON THE PREMISES Type/Breed/Size Sex/Neutered/Spayed Indoor/Outdoor Pet’s Name 1. _____________________________________________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________________________________________ LIST ALL BANK ACCOUNTS Bank Name Account# Checking/Savings Balance 1. _____________________________________________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________________________________________ CREDIT REFERENCES – LOANS & CREDIT CARDS Account# Purpose $ Limit Balance Mo Payment Name 1. _____________________________________________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________________________________________ 3. _____________________________________________________________________________________________________________________________________ 4. _____________________________________________________________________________________________________________________________________ 5. _____________________________________________________________________________________________________________________________________ 6. _____________________________________________________________________________________________________________________________________ LIST TWO UNRELATED PERSONAL REFERENCES Name Address City/State/Zip Phone # 1. _____________________________________________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________________________________________ PERSONAL SKILLS: TOOLS YOUR OWN:

( ) Plumbing ( ) Carpentry ( ) Painting ( ) Electrical ( ) Mechanical Other_______________________________________________________________________________________________________ ( ) Tool Box ( ) Mower ( ) Yard tools ( ) Ladder ( ) Hoses/Sprinklers

1. Have you ever been evicted from any tenancy? ( ) Yes ( ) No 2. Have you ever willfully and intentionally refused to pay rent when due? ( ) Yes ( ) No 3. Do you know of any thing which could interrupt your income or ability to pay rent? ( ) Yes ( ) No 4. Rent is due in advance on the last business day of each month. Are you able to fulfill this requirement? ( ) Yes ( ) No 5. Have you ever filed a petition of bankruptcy? If yes, when & where? ____________________________ ( ) Yes ( ) No 6. Have you or anyone in your household ever been convicted of a felony or misdemeanor? If yes, explain ( ) Yes ( ) No 7. Would you be interested in purchasing this home, or other homes we might have available from time to time? ( ) Yes ( ) No 8. Are you obligated to pay child support or alimony? (If yes, how much? $_______________ per month) ( ) Yes ( ) No 9. Who will be living in the property with you? Name(s)/Age(s): ___________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ ANY ADDITIONAL INFORMATION YOU THINK WILL HELP US PROCESS YOUR APPLICATION (attach additional information if necessary) _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Applicant agrees that if for any reason applicant becomes delinquent in rents, or other charges, Landlord is hereby authorized to use applicant's Master Charge or Visa Account and said authorization is hereby given. Applicant also agrees that all credit information maintained by Landlord may be given to any credit reporting service or other persons who request it. Applicant hereby certifies that the information given in this application is true and correct. Applicant understands that any false answers or statements made will be sufficient grounds for termination and eviction. Applicant hereby authorizes Landlord to obtain a credit report. APPLICANT AGREES TO PAY THE REQUIRED FEE OF $20.00 FOR EACH INDIVIDUAL CREDIT REPORT. APPLICANT UNDERSTANDS AND AGREES THAT APPLICANT WILL NOT RECEIVE A COPY OF THIS CREDIT REPORT. Applicant authorizes present and past Landlords and Employers, Banks, Credit References, Personal References, and any other person to release information regarding applicant's credit, rental, employment and/or criminal histories. A copy of this authorization may be accepted as an original. Date ____________________

___________________________________________ Applicant's Signature ___________________________________________ Date of Birth (needed to pull credit report) Mail to: Scott Britton, Agent, P.O. Box 16204, Jackson, MS 39236-6204 APPLICATIONS WILL NOT BE PROCESSED WITHOUT THE $20.00 APPLICATION FEE!