14428 N. 56^th Pl.  Scottsdale, AZ 85254        Tel 480-797-8684          Fax 480-393-8684                                                                                                                    

Rental Property Address: ___________________________Today’s date: ____________

No. of Occupants: Adults(         ) Children(        )     Date desired: ___________________

No. of Pets: _____________ Type of Pets: ___________________________________

                                                                                          Applicant              Co-Applicant

Have you ever filed for bankruptcy?                                Yes(  )  No(  )       Yes(  )  No(  )

Have you ever been evicted from a rental property?        Yes(  )  No(  )       Yes(  )  No(  )

Have you ever been convicted of a felony?                      Yes(  )  No(  )       Yes(  )  No(  )

Personal Information

Applicant

Name of applicant: ________________________________________________________

Current address: __________________________________________________________

City:______________________________________, State:________ Zip:____________ Tel: (_____)_______-_________________  Cell: (_____)_______-_________________

*Email: _____________________________*Soc. Sec #: ________-_______-________ *DOB _______/_______/___________ DL# ___________________________________

Current Landlord:_____________________________ Tel(______)_______-__________

How long at address:____________________  Rent: $_________________

Co-Applicant (Spouse)

Name of applicant: ________________________________________________________

Current address: __________________________________________________________

City:______________________________________, State:________ Zip:____________ Tel: _________________________________  Cell:______________________________

*Email: ___________________________*Soc. Sec #: _________-______-__________ *DOB _______/_______/_________ DL# _____________________________________

Current Landlord:___________________________ Tel:(______)_______-___________

How long at address:____________________  Rent: $_________________

Employment (Applicant)                            (Co-Applicant)

Current Employer: ____________________ Current Employer: ____________________

Address:____________________________  Address:____________________________

Position: ____________________________ Position:____________________________

Supervisor:__________________________ Supervisor:__________________________

Tel:_________________ Hire Date ______ Tel:________________ Hire Date________

Monthly Income:_________________    Monthly Income:________________________

Bank & Personal References

In Emergency Notify:____________________________ Tel:(_____)____-___________

Address:_________________________________________ Relationship:____________

Banking Institute:________________ Sav Acc# __________Checking Acc#__________

Automobiles:

Make/Model ____________ Yr____ Color_________ Plate# _____________State_____

Make/Model ____________ Yr____ Color_________ Plate# _____________State_____

How were you referred to us?

_____ Newspaper _________________________________________________________

_____ Realtor ____________________________________________________________

____ Other ______________________________________________________________

**********************AGREEMENT*******************

-I/We, the undersigned, understand that __________________________________ is the leasing agent & representative for the owner/landlord & that the leasing agent’s fee will be paid by the owner/landlord.

-A credit check fee of ($35) is non-refundable

-Applicant shall deposit $________ as an Earnest Deposit to hold rental premises.

-If accepted, applicant agree to execute a written lease for the premises upon the terms above when requested to do so, at the same time applicant agrees to pay the balance of the first month rent & security deposit.

-If applicant has been accepted and fails or refuses to execute said lease, or to pay any of the monies said due, or chooses to withdraw their offer after making this application or falsifies any information, said deposit may be retained by broker as LQUIDATED DAMAGES & to defray losses on advertising, lost prospective tenants or rent losses.

I/We the undersigned, do herby authorize Sam W. Abraham Realty &/or its nominees or  affiliates, to investigate  the information supplied by me/us on the rental application concerning income, credit history, mode of living, character and criminal background for the purpose of verifying and qualifying my/our application for rental.  Any information that is found to be purposely misrepresented will result in the denial of this application or may be reason for eviction if discovery is made after occupancy.

Signature:_______________________________________  Date:___________________

Signature:_______________________________________ Date :___________________