Rental Application

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Rental Application Centerpointe Invesments L.L.C. 67 South Higley Rd. Suite 103-195, Gilbert, AZ 85296

Date:

Applicant Last Name:

Application is hereby made to rent the premises generally described as 21 South 500 East Pleasant Grove UT 84062 For a term of 12 Months. Starting on the 1st of July 2009 . For which monthly rental rate shall be $800.00 plus all utilities payable in advance. A security deposit in the amount of $800.00 along with the first months rent of $800.00 shall be due prior to occupancy of the premises. The security deposit of $800.00 is made with the understanding that if this application is accepted and the applicant fails to execute a lease before the beginning date specified above, or to pay the balance due as first months rent, said security deposit will be forfeited as liquidated damages. It is also understood that if this application is not accepted, or if the premises are not ready for occupancy by the above starting date, said security deposit shall be refunded to the applicant forthwith, upon the applicant’s request. Applicant: Name:

Phone:

Present Address:

How Long:

Previous Address:

How Long:

Marital Status: Married [

] Single [

Children: Yes[

] How Many:

] No [

Do you own any pets: Yes [

] No [

] Spouse’s Name: Ages:

] What Kind:

How Many:

Your Employment: (Applicant)

Employer: Employer Address:

Supervisor Name: How long on present job:

Bus. Phone: Annual Income: $

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2nd or Previous Employer Employer: Employer Address:

Supervisor Name: How long on present job:

Bus. Phone: Annual Income: $

Spouse’s Employment: (Co-Applicant) Employer: Employer Address:

Supervisor:

Bus. Phone:

How long on present job:

Annual Income: $

Reference: Bank Statements: Please include the most recent (3) Months bank statements with your application. For privacy purposes please ensure that there are no Social Security Numbers, Account Numbers or PIN numbers visible on the statements. Names, dates and ending balance is required.

Personal Reference:

Phone:

Credit Reference:

Phone:

Previous Landlord:

Phone:

The information provided in this application is deemed to be correct and true to the best of my knowledge. This information may be used by Centerpointe Investments L.L.C. in determining the outcome of this application.

X Applicant Signature

Date

X Co-Applicant Signature

Date