Green Realty Group - Rental Application

Property Address
I am
Date:

MonthDayYear
Enter Date
Person Filling out form

First NameLast Name
Email Address
example@example.com
Signature

Clear
Use finger or mouse to sign

Household Information: Complete the following information for each household member that will occupy the unit at time of move-in:

Note: Do not provide Social Security Number of anyone under 18 years of age

	Name (First, MI, Last)	Relationship to the Head of Household	Sex (M/F)	Birth Date (mm, dd, yyyy)	Student (Y/N)	Social Security Number
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6
Person 7
Person 8
Person 9

Current Address:
Primary Phone

Area CodePhone Number
Alternate Phone

Area CodePhone Number
Emergency Contacts
1. Name:
Relationship to You:
Address:
Telephone:

Country CodeArea CodePhone Number
2. Name:
Relationship to You:
Address:
Telephone:

Country CodeArea CodePhone Number
Housing References:

List the past 3 years of housing references.
1.
Landlord's Name
Landlord's Address
Phone Number

Area CodePhone Number
Your Address
Own/Rent

OwnRent
From

MonthDayYear
Date
To

MonthDayYear
Date
2.
Landlord's Name
Landlord's Address
Phone Number

Area CodePhone Number
Your Address
Own/Rent

OwnRent
From

MonthDayYear
Date
To

MonthDayYear
Date
3.
Landlord's Name
Landlord's Address
Phone Number

Area CodePhone Number
Your Address
Own/Rent

OwnRent
From

MonthDayYear
Date
To

MonthDayYear
Date

Do you or anyone listed above own a vehicle?
Vehicle Identification:

	License #	State Issued	Make/Model/Year
1
2

All questions that were answered YES on this application will be verified through the appropriate third-party source. It will be your responsibility to provide management with all necessary information to properly process your application and verify your eligibility. This will include names, addresses, phone and fax numbers, account numbers (where applicable), and any other information required to expedite this process.
Signature Clause:
Signature Clause:

I/We understand that management is relying on this information to prove my household’s eligibility for housing. I/We certify that all information and answers to the questions are true and complete to the best of my knowledge. I/We consent to release the necessary information to determine my eligibility. I/We understand that providing false information or making false statements may be grounds for denial of my application. I/We also understand that such action may result in criminal penalties.

I/We consent to have management verify the information contained in this application for purposes of proving my eligibility for occupancy. I/We will provide all necessary information and expedite this process in any way possible. I/We understand that my occupancy is contingent on meeting management’s resident selection criteria.

I/We understand that in compliance with the FAIR CREDIT REPORTING ACT the processing of this application includes but is not limited to making any inquiries deemed necessary to verify the accuracy of the information I/We provided, including procuring consumer reports from consumer credit reporting agencies and obtaining credit information from other credit institutions.

I/We hereby grant this property owner and/or agent, BVIR Community Development Corporation, the right to process this application for the purpose of obtaining a Rental/Lease Agreement with this property. Additionally, I/We authorize all corporations, companies, law enforcement agencies, academic institutions, and current and former employers to release information they may have about me/us and release them from any liability and responsibility from doing so. A photographic or faxed copy of this authorization shall be as valid as the original.

I/We agree to pay $50.00/adult for the application fee. This is a non refundable fee to cover our administrative costs. Completion of this application does not mean I/we will be guaranteed tenancy. I/We understand that in any information within this application is found to be untrue, it is grounds for termination of the tenancy. I/We also understand that any default in the payment of rent will affect any future application for tenancies, credit, or insurance.
If the application is not approved or accepted by the owner or agent, the security deposit, if any, will be refunded. I/We recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I/We may be acquainted. This inquiry includes information as to my/our character, general reputation, personal characteristics and mode of living as permitted by state law.

All household members 18 and over must sign below:
Signature

Clear
Date

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date

For Office Use Only
Application Fee:
Application Date:

MonthDayYear
Date
Time

:HourMinutesAM/PM Option
Desired Move-In Date:

MonthDayYear
Date
Application Received By:
Office Notes
Should be Empty:

Emergency Contacts

Housing References:

Household Information (continued)

Income Information

Asset Information

Signature Clause:

For Office Use Only

	Household Member	Name of Company	Amount

	Household Member	Name of Company	Amount

	Household Member	Name of Company	Amount

	Household Member	Name of Company	Amount