PLEASE READ CAREFULLY                        15.00 FEE CREDIT CHECK

Applicant Authorization and Consent for Release of Information

 

This release and authorization acknowledges that Landlords Tenant Credit Bureau may now, or at any time while

employed conduct and inquiry.  This inquiry may include the following:

 

·         Employment

·         Credit History

·         Motor Vehicle Record

·         Criminal History

·         Social Security Verification

 

I/we hereby authorize Landlord Tenant Credit Bureau and any of its agents or attorneys to conduct an inquiry

authorized by this release.

 

I/we have read and understand this release and consent form, and I authorize the background inquiry and

verification.  I specifically authorize present employer(s) and other organizations and/or agencies to provide

all information requested and I hereby release all of the persons or entities providing such information from

any photocopy of this document are as valid as the original.

 

I/we do hereby agree to forever release and discharge LANDLORDS TENANT CREDIT BUREAU, its

employees, and agents, from any claims, damages, losses, liabilities created by the retrieval and reporting

of the information authorized by this release.

 

                                                                                                                                                                                               

Applicant Name (printed): (First, Middle, Last)                                                              Date

 

                                                                                                                                                                                               

Signature                                                                                                                  Social Security Number

 

                                                                                                                                                                                               

Address                                                                                                                    Date of Birth

 

                                                                                                                                                                                               

City, State, Zip                                                                                                          Phone Number (Home & Work)

 

                                                                                                                                                                                               

Mailing Address if Different                                                                                         Driver License/I.D. Number

 

                                                                                                                                                                                               

Co-applicant Name (printed): (First, Middle, Last)                                                         Date

 

                                                                                                                                                                                               

Signature                                                                                                                  Social Security Number

 

                                                                                                                                                                                               

Address                                                                                                                    Date of Birth

 

                                                                                                                                                                                               

City, Sate, Zip                                                                                                           Phone Number (Home & Work)

 

                                                                                                                                                                                               

Mailing Address if Different                                                                             

 

 

 

IN COMPLIANCE WITH THE INTERNAL REVENUE CODE, SECT. 103 (B) AND THE CITY OF HOLLAND, LENDING INSTITUTES,
APPLICANTS DESIRING TO LEASE AND OCCUPY AN APARTMENT ARE REQUIRED TO COMPLETE THE FOLLOWING
APPLICATION FORM IN IT’S ENTIRETY.

 

 

Applicant’s Household:  List all household members who will live in the rented premises.

                Name                                                         Age                        Relationship                Occupation/School Grade 

 

1.                                                                                                                                                                                            

 

2.                                                                                                                                                                                            

 

3.                                                                                                                                                                                            

 

4.                                                                                                                                                                                            

 

5.                                                                                                                                                                                            

 

Description of All Vehicles:

           Make/Model                                       Year                        Color                          License Plate                         State

 

1.                                                                                                                                                                                            

 

2.                                                                                                                                                                                            

 

3.                                                                                                                                                                                            

 

Rental History:

Length of time at current address and reason for moving:                                                                                                            

                                                                                                                                                                                               
 

Name and phone number of present landlord:                                                                                                                              

 

Previous address:                                                                                                                                                                     

 

Length of time at previous address and reason for moving:                                                                                                            

 

                                                                                                                                                                                              

 

Name and phone number of previous landlord:                                                                                                                             

 

Have you ever broken a lease?                           Been asked to leave?                           Been evicted?                       


If yes, please explain:                                                                                                                                                               

 

Has any of your security deposit been withheld by the landlord?               If yes, what for?                                 


Applicant’s Employment/Financial Background:

 

Current occupation:                                                                                              Length of Time:                                  

(If less than one year, please list previous employment on reverse)

 

Employers name & address:                                                                                                                                                     

 

Employer contact name & telephone number:                                                                                                                               

Hourly rate:                            Hours per week:                                   Take home amount per week:                             

 

Other sources of income:                                                                                                                                                          

 

Co-Applicant’s Employment/Financial Background:

 

Current occupation:                                                                                              Length of Time:                                           

(If less than one year, please list previous employment on reverse)

 

Employers name & address:                                                                                                                                                    

 

Employer contact name & telephone number:                                                                                                                              

 

Hourly rate:                            Hours per week:                                   Take home amount per week:                             

 

Other sources of income:                                                                                                                                                        

References (must be other than family):

 

Name:                                                                                                      Phone: (                )-             -                              

 

Address:                                                                                                                                                                               

 

Name:                                                                                                      Phone: (                )-             -                              

 

Address:                                                                                                                                                                               

 

I AGREE THAT YOU MAY OBTAIN AN INVESTIGATIVE CREDIT REPORT IN CONNECTION WITH THIS

APPLICATION.  ($15 MUST BE SUBMITTED WITH THIS APPLICATION FOR THE CREDIT REPORT.)

I ALSO AUTHORIZE YOU TO OBTAIN AN EMPLOYMENT REPORT IN CONNECTION WITH THIS APPLICATION.

 

I HAVE READ BOTH PAGES OF THIS APPLICATION AND I HEREBY STATE AND REPRESENT THE

INFORMATION PROVIDED BY ME IS COMPLETE AND ACCURATE.  I ACKNOWLEDGE AND AGREE

THAT IN THE EVENT I ENTER INTO A LEASE WITH MANAGING COMPANY FOR THE OWNER

AND IF ANY INFORMATION HAS BEEN FALSIFIED THAT THE LEASE MAY BE BROKEN OR AT

ANY TIME THE INFORMATION ABOVE CHANGES, I MUST NOTIFY THE MANAGING AGENT,

AT WHICH TIME IT IS AT THE OPTION OF THE NANAGING AGENT TO ALLOW THE CHANGES.

 

THE UNDERSIGNED ALSO ACKNOWLEDGES THAT COMPLETING AN APPLICATION DOES NOT

AUTOMATICALLY ENTITLE THEM TO AN APARTMENT.  THIS APPLICATION MUST BE APPROVED

PRIOR TO ACCEPTANCE.

 

                                                                                                                                                                                               

                                APPLICANT’S SIGNATURE                                                                                        DATE

 

                                                                                                                                                                                               

                                CO-APPLICANT’S SIGNATURE                                                                                  DATE

 

 

PLEASE RETURN TO: CARINI & ASSOCIATES REALTORS INC.                     

                                         587 EAST 8TH STREET, SUITE A

                                          HOLLAND, MICHIGAN, 49423

                                        (616) 393-0444 or  (800) 411-6683