LOISE LANE HOUSING PROPERTIES INC

Failure to complete this application in its entirety

may result in denial of approval
PLEASE PRINT LEGIBLY
APPLICATION

Please circle one: RENTAL or LEASE OPTION (Cash/Bank Purchase)

Address of Property for which you are applying

Date of Desired Move-in Max Dn Payment/Security Dep Amount $ (Required. Do Not Leave
Blank)
How soon you want to pay the deposit Do you have the payment with you? YES or NO (please circle)

Applicant: Co-Applicant:

Applicant’s Name _____________________________ Co-Applicant’s Name _____________________________ Home

Phone: ________________________________ Home Phone: ________________________________

Cell Phone: _________________________________ Cell Phone: _________________________________

Work Phone: ________________________________ Work Phone: ________________________________

Email ______________________________________ Email ______________________________________

Driver’s License Number _______________________ Driver’s License Number _______________________

Social Security Number _________-____-__________ Social Security Number _________-____-__________

Date of Birth: ____________________ Date of Birth: ____________________

Current Address: ______________________________ Current Address: ______________________________

City _______________ State _____ Zip __________ City _______________ State _____ Zip __________

Current Residence: Own or Rent (please circle one) Current Residence: Own or Rent (please circle one)

How long at current residence? ________ ___________ How long at current residence?
___________________

Reason for Moving? ___________________________ Reason for Moving? ___________________________

Current Rent/Payment amount: _______________ /mo Current Rent/Payment amount: _________________ /mo

Landlord _____________________ Phone ___________ Landlord:_____________________ Phone___________

Previous Address: ____________________________ Previous Address: ____________________________

City _______________ State _____ Zip __________ City _______________ State _____ Zip __________

Previous Residence: Own or Rent (please circle one) Previous Residence: Own or Rent (please circle one)

How long at previous residence?__________________ How long at previous residence?__________________

 LOISE LANE HOUSING PROPERTIES INC

Reason for moving? ____________________________ Reason for moving? ____________________________

Rent/Payment Amount: _____________________/mo Rent/Payment Amount: _____________________/mo

Landlord (if applicable) _________________________ Landlord (if applicable) _________________________

Landlord Phone _______________________________ Landlord Phone _______________________________

Current Employer _____________________________ Current Employer _____________________________

Position ______________________________ Possition ______________________________

Date Began ______________________________ Date Began ______________________________

Employer Address _____________________________ Employer Address _____________________________

Supervisor Name _____________________________ Supervisor Name _____________________________

Employer Phone: _____________________________ Employer Phone: _____________________________

Salary _________________ Pay per hour ___________ Salary _________________ Pay per hour ___________
Total (Before Tax) Monthly Income ________________ Total (Before Tax) Monthly Income ________________

Previous Employer _____________________________ Previous Employer _____________________________

Date Began-End ______________________________ Date Began-End ______________________________

Salary _________________ Pay per hour ___________ Salary _________________ Pay per hour ___________

Other Income(From/Amount): _____________________ Other Income(From/Amount): _____________________

Applicant Total: ________ ________ Co-Applicant Total: ________ ________

AUTOMOBILES

MAKE & MODEL _______________ COLOR__________YEAR __________ PMT $__________ MAKE

& MODEL _______________ COLOR__________YEAR __________ PMT $__________

PERSONAL INFORMATION

NEAREST RELATIVE ____________________________________ PHONE ______________________

OTHERS WHO WILL LIVE WITH YOU & AGES ___________________________________________

HAVE YOU EVER FILED BANKRUPTCY? YES or NO (please circle) WHEN? ___________

HAVE YOU EVER HAD A REPOSSESSION? YES or NO (please circle) WHEN? ___________

DO YOU HAVE ANY LIENS, JUDGEMENTS, OR CHARGEOFFS AGAINST YOU? Y or N (please circle)

If Yes – Give Details of each__ ___________________________________________________________________

HAVE YOU EVER REFUSED TO PAY RENT? ________ WHY? _______________________________ HAVE
YOU EVER BEEN EVICTED? __________ IF SO, WHEN? ______________________________

HAVE YOU EVER BEEN CONVICTED OF A CRIME? Y or N If Yes, Please Explain __________________________________

DOES ANYONE WHO WILL LIVE IN HOUSE SMOKE? Yes No

 LOISE LANE HOUSING PROPERTIES INC

TYPE OF PET(s) _____________________ WEIGHT _______________ NAME _____________________

I DECLARE THAT THE STATEMENTS ABOVE ARE TRUE AND CORRECT, AND I AUTHORIZE VERIFICATION OF REFERENCES,
EMPLOYMENT, AND A CONSUMER CREDIT CHECK. I ALSO UNDERSTAND THAT ANY DEPOSIT GIVEN WITH THIS
APPLICANTION TO HOLD THE UNIT IS NON-REFUNDABLE UNLESS THIS APPLICATION IS REJECTED BY THE LESSOR.
I AUTHORIZE ______________________________________, ITS AGENTS AND/OR ASSIGNS TO OBTAIN INFORMATION ABOUT ME
FROM CURRENT AND PREVIOUS LANDLORDS AND EMPLOYERS, CRIMINAL BACKGROUND CHECKS AND PERSONAL
CHARACTER REFERENCES. I AUTHORIZE MY CREDIT SOURCES, CURRENT AND PREVIOUS LANDLORDS AND
EMPOLOYERS, AND PERSONAL REFERENCES TO DISCLOSE TO LANDLORD SUCH INFORMATION ABOUT ME AS THEY MAY
REQUEST. I UNDERSTAND THAT PURSUANT TO FEDERAL LAW, I MAY REQUEST IN WRITING THE NAME AND ADDRESS OF
THE CREDIT REPORTING AGENCY USED BY THE LANDLORD. I UNDERSTAND THAT I WILL NOT RECEIVE A COPY OF THE
CREDIT REPORT FROM THE LANDLORD, BUT MAY REQUEST A COPY DIRECTLY FROM CREDIT BUREAUS.

__________________________________________ _______________

APPLICANT’S SIGNATURE DATE

__________________________________________ _______________

CO-APPLICANT’S SIGNATURE DATE