RENTAL APPLICATION Application is not complete until page 4 is signed. Unless this application is initialed on each page it will not be processed. (If more than two persons are applying, use additional applications.) PROPERTY ADDRESS

REQUIRED TO SUBMIT: (Cash, MO, CC) Application (Non-Refundable) Fee $ 75.00 Deposit to Hold $ Amt. Received $

CITY, STATE, ZIP MOVE-IN DATE (NON-REFUNDABLE) APPLICATION FEE $ 75.00 $

PET DEPOSIT $

RENT $

SECURITY DEPOSIT

(NON-REFUNDABLE) PROCESSING FEE $

KEY DEPOSIT $

CLEANING FEE $

EVIDENCE BY: CASH

CHECK

OTHER $ CASHIER'S CHECK

MONEY ORDER

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX APPLICANT: HOME PHONE #

OTHER PHONE

EMAIL

SSN#

DL#

STATE

BIRTH DATE

CURRENT ADDRESS: CITY, STATE, ZIP LANDLORD NAME / MORTGAGE HOLDER: PHONE #

PAYMENT:

HOW LONG?

(PLEASE CHECK ONE)

OWNED OR

RENT

(PLEASE CHECK ONE)

OWNED OR

RENT

REASON FOR LEAVING PRIOR STREET ADDRESS: CITY, STATE, ZIP LANDLORD NAME / MORTGAGE HOLDER: PHONE #

HOW LONG?

REASON FOR LEAVING CURRENT EMPLOYER: HOW LONG?

EMPLOYED AS

ADDRESS: CITY, STATE, ZIP PHONE # Rental Application Rev. 11/09

FAX# Page 1 of 4

Applicants Initials: [

Desert Winds Realty & Property 6550 S Pecos Ste 132 Las Vegas, NV 89120 Phone: (702)451-8797 Fax: (702)436-5832 Jackie Porter Produced with ZipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026

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www.zipLogix.com

SALARY: $

PER/MO SUPERVISOR:

OTHER INCOME: SOURCE

AMOUNT: $

PRIOR EMPLOYER (IF LESS THAN 3 YEARS): HOW LONG?

PHONE #

EMPLOYED AS

SALARY: $

PER/MO SUPERVISOR:

CREDIT REFERENCES: BANK

ACCT.#

ADDRESS XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX CO-APPLICANT: SSN #

DL#

PHONE #

STATE

BIRTH DATE

EMAIL

CURRENT ADDRESS: CITY, STATE, ZIP LANDLORD NAME / MORTGAGE HOLDER: PHONE #

PAYMENT:

HOW LONG?

(PLEASE CHECK ONE)

OWNED OR

RENT

(PLEASE CHECK ONE)

OWNED OR

RENT

PRIOR STREET ADDRESS: CITY, STATE, ZIP LANDLORD NAME / MORTGAGE HOLDER: PHONE #

HOW LONG?

REASON FOR LEAVING CURRENT EMPLOYER: HOW LONG?

EMPLOYED AS

ADDRESS: CITY, STATE, ZIP PHONE #

FAX#

SALARY: $

PER/MO SUPERVISOR:

OTHER INCOME: SOURCE AMOUNT: $ PRIOR EMPLOYER (IF LESS THAN 3 YEARS): HOW LONG?

PHONE #

EMPLOYED AS

SALARY: $

PER/MO SUPERVISOR:

Rental Application Rev. 11/09

Page 2 of 4

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CREDIT REFERENCES: BANK

ACCT.#

ADDRESS XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX AUTOMOBILES: MAKE

MODEL

LIC#

STATE

YR

COLOR

MAKE

MODEL

LIC#

STATE

YR

COLOR

MAKE

MODEL

LIC#

STATE

YR

COLOR

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX IN ADDITION TO APPLICANT(S), OTHER PERSONS TO BE AT PREMISES: NAME

PETS? (Y/N)

HOW MANY? Cats Name

RELATIONSHIP

AGE

Dogs

Other

Cat or Dog?

Breed

OCCUPATION

Weight

Spayed or Neutered?

If Other, please explain:

HAS ANY APPLICANT EVER FILED BANKRUPTCY?

HAS ANY APPLICANT EVER BEEN EVICTED?

GIVE DETAILS

EXPLAIN

HAS ANY APPLICANT EVER WILLFULLY REFUSED TO PAY RENT WHEN DUE?

EXPLAIN

HAS ANY APPLICANT OR OCCUPANT EVER BEEN CONVICTED OF A GROSS MISDEMEANOR OR FELONY? YES

OR NO

IF YES PLEASE EXPLAIN

Rental Application Rev. 11/09

Page 3 of 4

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HOW LONG DOES APPLICANT PLAN TO LIVE HERE? FURNITURE?

DOES APPLICANT PLAN TO USE LIQUID FILLED

TYPE

DOES ANYONE IN THE HOUSEHOLD SMOKE? Y/N APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY: RELATIONSHIP:

PHONE #

CO-APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY: RELATIONSHIP:

PHONE #

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX DISCLOSURE PLEASE READ CAREFULLY BEFORE SIGNING 1. APPLICANT UNDERSTANDS THAT Jackie Porter IS THE LEASING AGENT AND REPRESENTATIVE FOR THE LANDLORD OF THE PREMISES LOCATED AT AT A MONTHLY RENT OF $ . 2. APPLICANT DECLARES THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT, AND APPLICANT AUTHORIZES AN EMPLOYMENT CHECK, CRIMINAL RECORDS CHECK, CREDIT CHECK, VERIFICATION OF REFERENCES AND CURRENT AND PREVIOUS LANDLORDS. 3. APPLICANT HEREBY PAYS $ 75.00 AS A NON-REFUNDABLE APPLICATION FEE AND $ AS HOLDING DEPOSIT. IF APPLICANT IS DECLINED, HOLDING DEPOSIT SHALL BE REFUNDED WITHIN N/A BUSINESS DAYS. IF, AFTER APPROVAL, APPLICANT DECIDES NOT TO FULFILL THIS AGREEMENT BY COMPLETING LEASE AND PAYING FIRST MONTHS RENT AND REMAINING SECURITY DEPOSIT, HOLDING DEPOSIT SHALL BE RETAINED BY LANDLORD TO COVER ADMINISTRATIVE EXPENSES. 4. APPLICANT AGREES TO EXECUTE A RENTAL AGREEMENT BEFORE POSSESSION IS GIVEN AND TO PAY THE RENT AND SECURITY DEPOSIT WITHIN BUSINESS DAYS AFTER BEING NOTIFIED OF ACCEPTANCE OF THIS APPLICANT. 5. LANDLORD AND AGENT WILL NOT BE BOUND BY ANY REPRESENTATIONS, AGREEMENTS OR PROMISES, WRITTEN OR ORAL, MADE BY LANDLORD OR AGENT UNLESS CONTAINED IN THE RENTAL AGREEMENT SIGNED BY LANDLORD OR LANDLORD'S AGENT. 6. APPLICANT DOES HEREBY RELEASE LANDLORD, AGENT AND THIS COMPANY FROM ANY AND ALL DAMAGES OR LIABILITIES WHICH MIGHT RESULT FROM THE ABOVE INFORMATION. APPLICANT RELEASES PRESENT LANDLORD AND ALL PREVIOUS LANDLORDS FROM ANY AND ALL LIABILITY FOR ANY DAMAGE OR INJURY WHATSOEVER CAUSED BY PROVIDING INFORMATION TO LANDLORD OR AGENT REGARDING APPLICANT. 7. APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT A FALSE STATEMENT MADE HEREIN IS GROUNDS FOR DENIAL OF RENTAL TO APPLICANT. ANY STATEMENT HEREIN MAY BE CONSTRUED AS A CONDITION PRECEDENT TO ANY BINDING RENTAL AGREEMENT OR CONTRACT BETWEEN APPLICANT AND LANDLORD. 8. APPROVAL FOR RESIDENCY IS MADE WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, OR HANDICAP. 9. APPLICANT UNDERSTANDS THAT APPLICANT ACQUIRES NO RIGHTS TO PREMISES UNTIL EXECUTION OF A RENTAL AGREEMENT IN THE FORM SUBMITTED AND DEPOSIT OF RENT AND SECURITY DESCRIBED ABOVE. SIGNATURE OF APPLICANT

DATE

TIME

SIGNATURE OF CO-APPLICANT

DATE

TIME

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX OFFICE USE ONLY: MLS # DATE PAID REFERRAL COMPANY P.I.D. #

AGENT:

LICENSE #

THE GREATER LAS VEGAS ASSOCIATION OF REALTORS® PROVIDES THIS FORM FOR MEMBERS ONLY AND IS NO WAY DEEMED RESPONSIBLE FOR INFORMATION PROVIDED THEREIN. Rental Application Rev. 11/09

Page 4 of 4

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Rental Application.pdf

PAYMENT: 75.00. 75.00. Desert Winds Realty & Property 6550 S Pecos Ste 132 Las Vegas, NV 89120. (702)451-8797 (702)436-5832 Jackie Porter blank.

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