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Mail to: Scott Britton, Agent, P.O. Box 16204, Jackson, MS 39236-6204
APPLICATIONS WILL NOT BE PROCESSED WITHOUT THE $20.00 APPLICATION FEE!
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 willreside 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 whichcase 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 theproperty 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 addressof 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 # ______________
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