Please Print and complete information and bring into 201 N. Main St. Hennessey or Mail to P.O. Box 365 Hennessey, OK 73742
405-853-4858
eaglere@pldi.net
APPLICATION FEE: $30
(NON REFUNDABLE, APPLICATION WILL NOT BE CONSIDERED WITHOUT THE FEE)
Address of Property that you wish to rent ____________________________________________
Name ____________________________ SS#: ______________ Date of Birth: _____________
Driver’s License Number and State _______________________
Co-Applicant_______________________ SS#: _______________ Date of Birth: ____________
Driver’s License Number and State _______________________
Present Address: _______________________________________________________________
Telephone: _________________________ Cell Phone Number: _________________________
Email Address: _________________________
Names and ages of all persons to reside in residence.
____________________________________________________________________________________________________________________________________________________________
Number of vehicles: ___________
EMPLOYMENT HISTORY
Present Employer ____________________________________ Supervisor: ________________
Address of Employer: __________________________________________________________
Employer Telephone # ________________________________
Date employed _____________ Position _____________ Gross Annual Salary: _____________
Former Employer: _______________________________________
Co Applicant Employer _______________________________ Supervisor: ________________
Address of Employer: __________________________________________________________
Employer Telephone # ________________________________
Date employed _____________ Position _____________ Gross Annual Salary: _____________
Former Employer: _______________________________________
Other Income: ______________________________________
If Student, who is responsible for your finances: _____________________________________
Telephone # _______________________ Relationship: ______________________________
Complete Address: ____________________________________________________________
Past Rental References (if any):
Where have you rented before? ______________________________________________
Name of Past Landlord _____________________________ Phone # _____________________
Did you always pay on time? ________________
Rental History
PLEASE LIST TWO MORE PLACES OF RESIDENCE
NAME OF APT. BLDG OR HOUSE ADDRESS AND MANAGER
______________________________________________________________________________
Manager’s Phone Number __________________________ Amount of Monthly Rent _________
Dates From/To __________________________________________
NAME OF APT. BLDG OR HOUSE ADDRESS AND MANAGER
______________________________________________________________________________
Manager’s Phone Number __________________________ Amount of Monthly Rent _________
Dates From/To __________________________________________
Have you or any proposed occupant listed ever:
Been convicted or pled guilty to a misdemeanor involving violence, sexual misconduct, theft or drug related crimes? _____________NO
_______________YES EXPLAIN _____________________________________________________________________________
______________________________________________________________________________
Been convicted or pled guilty to any felony? _____________NO _______________YES EXPLAIN
_____________________________________________________________________
Been evicted or asked to move out? _________________________________________________
Broken a lease or rental agreement? _________________________________________________
Declared bankruptcy? _________________________
Been sued for nonpayment? _______________________________
Been sued for damage to property? ______________________________
Had a recorded lien, or garnishment or judgment against you? ____________________
If answered Yes to any of the above, please indicate year, location and explanation.________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Management will conduct verification of all information of rental application.
Management reserves the right to unilaterally deny this application should there be any changes or new information available regarding employment, compensation or any other significant item provided or requested herein between the time of the acceptance of this application by management and the move-in date; and /or if this application is not accepted by Management within 7 days from the date of this application.
Any falsification or unverifiable information could or will be grounds for denial of said rental application. Applicant represents that all the above information and statements are true and correct and hereby authorizes verification of the above items.
Applicant agrees that Management shall not be liable for any delay in the date said until the unit is ready for occupancy. Applicant also agrees to the first month rent and security deposit must be paid by cashier’s check or money order prior to move in date.
Expected Move in Date __________________________________
Signature of Applicant ___________________________________ Date: _________________
Signature of Co Applicant ________________________________ Date: __________________
Landlord/Manager Signature _______________________________ Date: _________________