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                                                        ACCURATE SCREENING & CREDIT REPORTING INC.                       

MANAGEMENT RESERVES THE RIGHT TO REFUSE TO CONSIDER THIS APPLICATION, UNLESS ALL QUESTIONS CONTAINED HEREIN ARE ANSWERED COMPLETELY.  THE RENTAL WILL STAY ON THE MARKET IF THE LEASE IS NOT SIGNED WITHIN 3 DAYS AFTER THE APPLICATION IS APPROVED.

Name of applicant_______________________________________     Name of spouse______________________________________

Date of birth ____/____/____ SSN______-______-_______                Date of  birth ____/____/____ SSN______- _____ -______

Drivers license # _________________________       State ______       Drivers license #____________________       State ________

Current address__________________________________________City_________________________State/Zip________________

Home phone__________________________ Length (MO/YR) From ____/____To ____/____Rent$______________Own$_______

Owner/Mgr/Agent______________________________________________________Phone#________________________________

Reason for leaving____________________________________________________________________________________________

Previous address___________________________________________City_________________________State/Zip_______________

Home phone__________________________ Length (MO/YR) From ____/____To____/____Rent$______________Own$________

Owner/Mgr/Agent______________________________________________________Phone#________________________________

Reason for leaving____________________________________________________________________________________________

Current Employer_________________________________  Address_________________________________________________

Supervisor _________________Bus. Phone__________  Position _____________ Salary $___________Length______________

Previous Employer_________________________________ Address__________________________________________________

Current Employer__________________________________ Address________________________________________________

Supervisor ________________  Bus. Phone__________ Position _____________  Salary$__________Length_____________

Previous Employer_________________________________ Address_______________________________________________

Supervisor_________________ Bus. Phone__________ Position______________ Salary$___________Length____________

1. ____________________________________________________Years Acquainted______________ Phone#__________________

2. ____________________________________________________Years Acquainted______________ Phone#__________________

Number of additional occupants_____________ Names/Ages__________________________________________________________

Do you own:         () Waterbed              () Aquarium           () Organ/Piano            () Boat           () Motorhome        () Cat     () Dog

Has you or your spouse ever broken a rental agreement? ___________ If yes, explain______________________________________

__________________________________________________________________________________________________________

Has you or your spouse ever been charges with a crime or convicted? _______ If yes, please explain. __________________________

__________________________________________________________________________________________________________

Has you or your spouse ever filed bankruptcy? _________ If yes, explain _______________________________________________

CORRECT INFORMATION Applicant represents that all of the above statements are true and complete, and hereby authorizes verification of above information, references, credit records, and criminal background check.  I further authorize ACCURATE SCREENING & CREDIT REPORTING Inc. disclose this information to owners and managers of homes or apartments I may apply to for tenancy.  Applicant acknowledges that false information herein may constitute grounds for rejection of this application, termination of occupancy, and or forfeiture of deposits and may constitute a criminal offense under the laws of the state.

APPLICANT AGREEMENT: This application is preliminary only and does not obligate Owner/Agent to execute a lease or deliver possession of the proposed premises.  I have received notification in writing that my application for tenancy is also a request of an investigative consumer report that included information as to my character, general reputation, personal characteristics, and mode of living, and that if my application is refused because of the findings, I may make a written request to ACCURATE SCREENING & CREDIT REPORTING INC. and receive a complete and accurate disclosure of the nature and scope of the report.

I understand I acquire no rights in the rental unit until I sign a rental agreement in the form submitted and make a security deposit in the amount of $___________, on the unit I have selected, said deposit to be held in accordance with the rental agreement.  In addition, I am paying a $40.00 NON REFUNDABLE CREDIT CHECK FEE. This is based on an average charged of $40.00 per credit check.  I further understand that the Property Management Co. may realize a minimum profit or loss from this transaction, depending upon the cost of the credit check. FEE MUST BE IN CASH OR MONEY ORDER ONLY.  I HAVE READ AND AGREE TO THE PROVISIONS STATED ABOVE.

APPLICANTS SIGNATURE________________________________________________________________DATE______________

CO-APPLICANT SIGNATURE_____________________________________________________________________________DATE_____________