100 Candlelight Way, Mt. Orab, Ohio 45154office@briarcreekproperties.com
Release of Information
I/We agree to permit an investigation of my credit, tenant, banking & employment history for the purpose of renting a residence with this owner/manager. It is understood that a photo/emailed copy of this form will also serve as an authorization.
100 Candlelight Way, Mt. Orab, Ohio 45154
office@briarcreekproperties.com
Rental Application & Authorization
Tenant Information:
Name: First Last Primary Phone: Address: Street City State ZipEmail: Email DOB: SSN: NumberName of Dependent 1: First LastDOB: Name of Dependent 2: First Last DOB: Does anyone listed above smoke? Please Select Yes No If yes how many? Do you have or plan to have any pets? Please Select Yes No If yes how many? How did you hear about us? Anyone 18 years or older need to fill out their own application.
Residential History (Last 2 Years):
Address 1: Street City State Zip
Date moved in: Reason for Moving:
Owner/Agent: Phone:
Address 2: Street City State Zip
Credit History:
Have you declared bankruptcy in the past 7 years? Please Select Yes No
Have you ever been evicted from a rental residence? Please Select Yes No
Have you had 2 or more late rent payments in the last year? Please Select Yes No
Have you ever willfully or intentionally refused to pay rent? Please Select Yes No
Employment History:
Employment Status: Please Select Full Time Part Time Student Retired Unemployed Employer:
Address: Street City State Zip
Dates Employed: Job Title:
Supervisor's Name: Phone:
Salary: Per
Provide copies of your last three months of pay stubs or other income verification.
If employed for less than 12 months, please provide previous employer:
Name: Phone:
If you have any other source(s) of income that you would like us to consider, please list it below. You do NOT have to reveal any alimony, child support or spouse's annual income unless you want us to consider in this application.
Amount: Source/Contact Name:
Banking Information:
Checking Savings Credit Union
Institution: Phone: Account #:
Address: Street Address City State Zip
How many checks have been returned in the last 6 months?
Emergency Contact Information:
Full Name: Relationship: Phone:
Vehicle Information (Including Company Vehicles):
Make: Model: Plate #:
Additional Information
The information that Briar Creek Properties, LLC obtains is only to be used in the processing of my application and will not be given to any other party.I hereby apply to lease a rental unit from Briar Creek Properties, LLC and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements above set forth are true; however, should any statement made above be misrepresentation or not a true statement of facts, all deposit will be retained to offset the agents cost, time, and effort in processing my application. When so approved and accepted, I agree to execute a lease for 12 months before possession is given and to pay the security deposit as well as first months rent prior to the move in date. I recognize that as part of your procedure for processing my application an investigative consumer report may be prepared whereby information is obtained through personal interviews with other with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living.The above information, to the best of my knowledge, is true and correct.