Lierly Lane Properties Online Application Form

(Please enter N/A in any field that is not applicable for your application.)

Desired Date of Occupancy

Date of Birth

Email Address

Telephone

Name (Last, First, Middle)

Cell Phone Number

Drivers License

Co-Occupants 1 (First Name, Last Name)

Co-Occupants 1 (Relationship)

Co-Occupants 2 (First Name, Last Name)

Co-Occupants 2 (Relationship)

Co-Opponents 3 (First Name, Last Name)

Co-Opponents 3 (Relationship)

Applicant Marital Status (Single, Married, Separated, Divorced)

Pet 1 (Yes, No)

Pet 1 Weight

Pet 2 (Yes, No)

Pet 2 Weight

Current / Previous Addresses:

Current Address

Current Rent

Current Landlord Name

Current Month and Year Moved In

Current Month and Year Moved Out

Current Landlord Fax Number

Current Landlord Phone Number

Current Landlord Email

Current Reason for Moving

Previous Address (If within 3 years)

Rent

How Long

Landlord Name

Phone Number

Month and Year Moved In

Month and Year Moved Out

Landlord Fax Number

Landlord Email Address

Reason for Moving

In Case of Emergency Notify:

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Address

Employment / Income: Applicant's Employer:

Name of Applicants Employer

Date Employed

Job Title

Employers Phone Number

Employers Address

Take Home Pay

Other Income

Applicant (Student Status):

Student Status (Full Time, Part Time, Other)

Level of Schooling (Undergraduate, Post Gradulate, Technical_

References:

Bank Checking Account:

Bank Name

Bank Phone

Bank Address

Bank Savings Account:

Bank Name (Savings)

Bank Phone (Savings)

Bank Address (Savings)

Credit:

Type of Credit No. 1

Name Credit 1

Credit 1 Phone

Address Credit 1

Type of Credit No. 2

Name Credit 2

Phone Credit 2

Address Credit 2

Personal References:

Name No. 1

Relationship No. 1

Phone No. 1

Address No. 1

Name No. 2

Relationship No. 2

Phone No. 2

Address No. 2

Vehicles:

Vehicle No. 1 Model

License Tag, State 1

Vehicle No. 2 Model

License Tag, State 2

Applicant's Agreement: Credit/Criminal: I hereby consent to allow Owner and/or its designated agents and employees, to obtain a consumer credit report and criminal record infomation for the purpose of determining whether to lease an apartment to me. I also agree and understand that Owner and/or its agents and employees may obtain additional consumer credit reports and criminal record reports on me in the future to update or review my account. Upon my request, Owner and/or its agents or employees will tell me whether consumer credit reports or criminal record reports were requested and the names and addresses of any consumer reporting agency that provided such reports.

Insurance: Neither the Owner nor its designated Agent or representatives carry insurance on the personal property of residents or other occupants; It is recommended that residents obtain insurance coverage.

Manager and Staff Represent Owner:Applicant(s) agree and understand that the Apartment Manager and all staff and employees of Owner represent the Owner exclusively in the apartment application and leasing process. Applicant(s) further understand that they may, at their own expense, select an agent or agents to represent them in the apartment application and leasing process. Verification:I represent that all of the information in this Rental Application is true and accurate to the best of my knowledge, and I acknowledge that Owner and its agents or representatives will rely on this informaiton in considering this application. All persons and/firms named above may freely give any requested information event that any of the foregoing information is discovered to be false, I waive any rights that I may have under applicable law to ntoice or the establishment of grounds for eviction and grant Owner or its agents or representatives the unconditional right to cancel my lease and immediately cause my eviction without prior notice or the establishment of grounds for eviction.

Certification Certification: For the purpose of allowing Owner or Owner's Agent to evaluate my application and determine my suitability as a resident, I hereby certify that neither I nor any potential occupants of my apartment have ever been charged with or convicted of a felony or any crime involving theft, violence, fraud, illegal drugs, or a sexual offense of any kind whatsoever.

I have read and agree with the above statements. (Yes, No - Must Be Yes To Apply)

Authorization: Authorization Electronic Signature Agreement: By entering your full name in the Accept box, you are signing this Agreement electronically. Your agree your electronic signature is the legal equivalent of your manual signature on this Agreement. 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 or 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 or their Authorized Agents to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employers 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 on this application.

I Accept (Type your full name)

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