Rental Application Form

I hereby make application to rent (address of rental property)

Property Applying for

Unit Number

Co-Signer

Your Information

First Name

Middle Name

Last Name

Suffix

DOB

SSN

Home Phone

All additional occupants (name, age, relationship):

Co-Applicants

Driver's License No

State of Issue

Cell Phone

Current Address

Address

Apt #

City

State

Zip

Landlord’s Name

Landlord’s Phone

Landlord Fax/Email Address

Reason For Moving

Monthly Rent

Rent/Own

When did you move in?

Was your name on the lease?

Previous Address

Address

Apt #

City

State

Zip

Landlord’s Name

Landlord’s Phone

Landlord Fax/Email Address

Reason For Moving

Monthly Rent

Rent/Own

When did you move in?

When did you move out?

Was your name on the lease?

Your Current Employment

Employer

City

State

Zip

Type of Business

Occupation/Rank

Manager/CO

Phone#

Employer Fax/Email Address

Hire Date

Mo. Salary

Prior/Current 2 Employment

Employer

City

State

Zip

Type of Business

Occupation/Rank

Manager/CO

Phone#

Employer Fax/Email Address

Hire Date

End Date

Mo. Salary

Your Personal History

Have you ever?...

been asked to move out or evicted?

broken a rental agreement or lease?

declared bankruptcy?

been sued for nonpayment or rent?

been sued for damage to a rental unit?

Additional income (interest, child support, etc.)

What state did you acquire your credit?

Have you ever used any other name?

If yes, name(s)

List installment payments made to mortgage, auto, other loans.

Company Name

City

State

Account #

Monthly Payment

Loan Balance

Company Name

City

State

Account #

Monthly Payment

Loan Balance

Car

Model

Color

Year

License #

Local Friend

Address

Phone #

Nearest Relative

Address

Phone #

Emerg. Contact

Address

Phone #

Pets

Type

Size

Comments (Max 250 characters)

ELECTRONIC SIGNATURE CONSENT

You have been asked to complete documents and a background screening authorization electronically and to receive legal notices electronically. To sign this authorization or any other document on this website electronically, fill out your name and last four digits of your Social Security number (“SSN”) and clicking the “Submit” button appearing at the bottom of the document. NOTE: Your electronic signature will not be applied to the document until you correctly complete all of these steps.

Once the signature process is completed, your electronic signature will be binding as if you had physically signed the authorization by hand.

If at any point you would like to withdraw your consent for your electronic signature, or if you need to update information needed to contact you electronically, please contact at CORNELL ASSOCIATES - CORPORATE. Any withdrawal of consent will be effective as of the date it is received.

Please check this box if you consent to provide an electronic signature rather than a handwritten signature in connection with any application or background screening documents, and whenever you sign documents on this website.

BACKGROUND CHECK AUTHORIZATION

In connection with my rental application, by checking the box and electronically signing my full name below, I authorize CORNELL ASSOCIATES - CORPORATE or Landlord (the “Landlord”) to order a “consumer report” (a background check report) about me and to verify information I have provided on my rental application. The background check company who will be conducting such checks is Tenant Data Services, Inc., P.O. Box 5404, Lincoln, NE 68505-0404, 800-228-1837, www.tenantdata.com.

In compliance with the Fair Credit Reporting Act and Washington Residential Landlord Tenant Act (for Washington applicants only), we are informing you that information as to your credit, character, general reputation, work and rental history, and mode of living is verified. The facts set forth in this application are true and complete. I, as the prospective tenant agree that a complete investigation of all on this application will not constitute invasion of privacy. I am aware of and extend the privilege to CORNELL ASSOCIATES - CORPORATE and/or its agents to obtain credit reports, rental references, employment verification, bank information, and sex offender registry information as necessary before and during tenancy. C&A has my permission to release information found in screening. I also agree to the release of information found in screening for any lawful purpose associated with the tenancy of the premises. I understand that any misrepresentations will be sufficient cause for dismissal or voiding of this application. I understand that I have a right to dispute the accuracy of information obtained in the screening and that if denied due to credit, I can, according to the Fair Credit Reporting Act, get a copy of my credit report from the credit wholesaler, Tenant Data, P.O. Box 5404, Lincoln, NE 68506. I agree to all the above and sign this of my own volition. C&A does not accept reusable tenant screening reports.

In the City of Seattle, the landlord is prohibited from requiring disclosure, asking about, rejecting an applicant, or taking an adverse action based on any arrest record, conviction record, or criminal history, except for registry information as described in subsections 14.09.025.A.3, 14.09.025.A.4, and 14.09.025.A.5, and subject to the exclusions and legal requirements in Section 14.09.115. Applicants may provide any supplemental information related to their rehabilitation, good conduct, and facts or explanations about registry information. Rev. 3.18

I understand that I have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any consumer report or investigative consumer report. I understand that the nature and scope of the most common form of investigative consumer report obtained with regard to tenants is an investigation into my prior rental history, education, and employment.

Selection criteria that may result in denial of my rental application includes: previous rental history; credit history; or failure to provide accurate or complete information on the application form.

I agree the Landlord may rely on this authorization to order background reports throughout my tenancy without asking me for my authorization again as allowed by law. I certify that all of the personal information I provided is true and correct.

APPLICANT NOTICES

Signing this authorization indicates that you have had the opportunity to review the Landlord's tenant selection criteria. The tenant selection criteria may include factors such as credit history, current income, and rental history. If you do not meet the selection criteria, or if you provide inaccurate or incomplete information, your application may be rejected and your application fee will not be refunded. You further understand that if your application is accepted, the Landlord will be reporting your performance as a renter to Tenant Data Services, Inc.’s database.

Electronic Signature

I understand that by typing my name and the last four digits of my SSN and by clicking on the “Submit” button below, I am electronically signing the above document.

I understand that my electronic signatures will be binding as though I had physically signed these documents by hand. I agree that a printout of this authorization may be accepted with the same authority as the original.

Applicant Signature

Date

Last Four SSN