Credit Form

Step 1 of 10 - Personal Information

Name of Applicant*
First Last
Telephone*
Email*
Enter Email Confirm Email
Applicant's birthdate
Today's Date
Date Format: MM slash DD slash YYYY
Are you over 18?
- Yes
- No

Social Security No.
Driver's License No.
Present Street Address
Street Address Address Line 2 City State ZIP Code
Name of Landlord and Phone No.
Current Rent Amount
Prior Street Address
Street Address Address Line 2 City State ZIP Code
Prior Landlord and Phone No.
How long have you lived at the present address?
How long have you lived at the prior address?

How many adults will be living in this unit?
How many children will be living in this unit?
How many pets will be living in this unit?
What is the weight of pets in pounds?
Employer
Occupation
Current Salary
How long with employer (years & months)?
Contact Person
Telephone

Is there a Co-Applicant?*
Name of Co-Applicant
Co-Applicant Email
Enter Email Confirm Email
Co-Applicant's Birthdate
Co-Applicant Telephone
Co-Applicant Security No.
Co-Applicant Driver's License No.
Co-Applicant Employer
Co-Applicant Occupation
Co-Applicant Current Salary
How long with employer (years & months)?
Contact Person
Contact Person Telephone

Bank Name
Bank Telephone
Bank Address
Street Address Address Line 2 City State ZIP Code
Checking Account No.
Savings Account No.

Number of vehicles (including company cars)
Please list each vehicle below. Please include make, model, year, color, tag no. and state

Have you ever filed for bankruptcy?
- No
- Yes
If yes, when?
Have you ever been served an eviction notice or asked to vacate a property you were renting?
- No
- Yes
If yes, when and why?
Have you ever willfully or intentionally refused to pay rent when due?
- No
- Yes
If yes, why?

How were you referred to us?
Please provide a name of the referral source you listed above

Rental Unit applied for
Commencement Date
Date Format: MM slash DD slash YYYY
Term
Rent/Month

Applicant hereby authorizes verification of any and all information set forth on this application, including release of information by any bank, savings and loan, employer (present and former), landlord, and/or other lender. All such information hereon, and released as authorized above, will be kept confidential. APPLICANT REPRESENTS THAT THE INFORMATION SET FORTH ON THIS APPLICATION IS TRUE AND COMPLETE. Material misrepresentation on this Application will constitute default under the lease or Rental Agreement between parties
Signature*
Permission*
- I give permission to Plaza Realty to run my credit.