Application

Rental Application
Property______________________________________________ (479) 521-9177 Office

Unit # _______ (479) 521-6199 Fax
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Applicant Name: Last First MI Birth date
__________________________________________________________________________________________
Driver’s Lic & State Soc. Sec. #
__________________________________________________________________________________________
Spouse’s Name: First MI Maiden Birth date

__________________________________________________________________________________________
Driver’s Lic & State Soc. Sec. #
__________________________________________________________________________________________
Expected Move in Date: ___________________ The number of people (include children) to live in unit: ______
Reason for Moving: ____________________________ Do you have any Pets: __________How many:_______
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Present Address City/State Zip How long Phone #
Name & Address of Landlord / Mortgage Co Telephone Monthly Payment
Applicant Employed By Supervisor’s Name How Long Salary
Spouse Employed By Supervior’s Name How Long Salary
Additional income (parents, alimony, separate maintence, child support, or other) if used for payment. Alimony,
separate maintenance, spousal support and child support are not requested, but may be disclosed by the
application if the applicant desires for Houses, Inc. to consider these sources of income when approving or denying any
application. Source _______________________________ Amount $ __________________ per ____________
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Credit Reference Account Number Address
Personal Reference Address City/Sate Zip Phone #
In Case of an Emergency and we can not reach you, we should call the following person:
Name Address City/Sate Zip Phone #
Automobile _____________Yr_______Lic #__________Automobile_____________Yr________Lic #_______

Have you ever been evicted from any apartment Community? _______Have you ever filed
bankruptcy?____________Do you have renters insurance_______Do you have a water bed?_______ Have you
ever been arrested and/or convicted of a Class A or B misdemeanor or a felony?_________If yes, explain
___________________________________________________________________State_______________ Are
you required or have you ever been required to register your address under any Megan’s law or sexual offender
law? _______ If yes, explain ________________________________________________________________
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**PLEASE READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION**.

Received from applicant $___________ .00. non-refundable fee to hold apartment for a maximum of
30 days. Upon credit approval and execution of a lease, fee will be applied to Security Deposit.
In case of credit denial, deposit will be refunded less cost occurred obtaining credit information.
Received from applicant a non-refundable application fee of $__________..00
Agency representation. Resident/Tenant understands that leasing agent firm is in the business of
representing the owners for the rental of real property and is paid a fee for such service. If the
resident/tenant decides to view or lease property from the owner represented by the leasing agent
firm, tenant hereby acknowledges that he/she has the right to obtain his/her representation. Houses, Inc.
its owners, employees, and agents, and the owners of each property managed by Houses, Inc.,
provide equal opportunity housing and will not discriminate against any person or impose
different terms and conditions on any person based on a person’s race, color, familial status,
religion, sex, age, physical or mental disability, or national origin.
We/I declare that all information is true and correct. We/I authorize Houses, Inc. to verify and obtain a
complete consumer history report, including but not limited to credit report, landlord verification,
employment verification, reference verifications, criminal background check, banks, or finance
companies. This information is not privileged and may be used for future reference.
______________________________________________________________________________
Application Signature/Date
______________________________________________________________________________
Spouse Signature/Date
______________________________________________________________________________
Received by/Date
If paying by credit card:

____ Visa ____ Master Card ____Discover ____ American Express
Credit Card # __________________________________________
Name on Card _________________________________________
Billing Address ________________

____________________________
CVC _________________________________________________
Expiration Date _________________________________________
Amount to Charge $______________________________________
Signature ______________________________________________

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Rental Application

Property______________________________________________ (479) 521-9177 Office

Spouse’s Name: First MI Maiden Birth date

Name & Address of Landlord / Mortgage Co Telephone Monthly Payment

Applicant Employed By Supervisor’s Name How Long Salary

Spouse Employed By Supervior’s Name How Long Salary

Personal Reference Address City/Sate Zip Phone #

Automobile _________Yr_Lic #__Automobile_YrLic #_

PLEASE READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION.

If paying by credit card:

Credit Card # __________________________________________

Name on Card _________________________________________

Billing Address ________________

Expiration Date _________________________________________

Amount to Charge $______________________________________

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