Medallion Management Application

One Application For Each Adult
Property Information
Property Address
Monthly Rent
Security Deposit
Desired Occupancy Date

MonthDayYear
Date
Applicant Information
Legal Name (Last/First/Middle)
Date of Birth

MonthDayYear
Date
Phone #
Email
example@example.com
Address History
Present Address
Present Landlord
Phone #
Relationship
Rent Amount
Move In
Move Out
Reason for Leaving
Prior Address
Prior Landlord
Phone #
Relationship
Rent Amount
Move In
Move Out
Reason for Leaving
Employment History
Present Employer
Address
Position
Supervisor
Phone
Salary (Monthly or Hourly)
Hours per Week
Start Date

MonthDayYear
Date
Previous Employer
Start Date / End Date

MonthDayYear
Date
Additional Source(s) of Income
Contact/Phone #
Contact/Phone #
List All Occupants

Occupant #1
Name
D.O.B.
Relationship
Occupant #2 (if applicable)
Name
D.O.B.
Relationship
Occupant #3 (if applicable)
Name
D.O.B.
Relationship
Occupant #4 (if applicable)
Name
D.O.B
Relationship
Occupant #5 (if applicable)
Name
D.O.B.
Relationship
Occupant #6 (if applicable)
Name
D.O.B.
Relationship
Additional Information
Have you ever filed bankruptcy?

YesNo
Have you ever been arrested or charged with a crime other than a traffic violation?

YesNo
Have you ever been evicted, asked to vacate or not paid rent when due?

YesNo
If you answered yes to any of the above, please explain
Release

Applicant understands and agrees that he/she has only applied for a tenancy. This form is not a lease. but an application and offer to lease, which may be accepted or rejected by Medallion Management. Medallion Management is a fair housing provider and will grant equal opportunity to all persons under the law. Applicant hereby grants to Medallion Management full authorization necessary to verify the information on this form, and to check applicant's credit history. rental history, criminal history, employment & income verification, information from public agencies and other information relevant to this application for a residential tenancy.
Signature of Applicant

Clear
Date

MonthDayYear
Date
Printed Name of Applicant
Thank you for submitting your application for this rental property. Verifiable information must be provided clearly on the enclosed application as requested.

Acceptance or denial of your application may be based in part, but not limited to, the following criteria:

INCOME: Verifiable income must be sufficient to meet our income policy.

CREDIT HISTORY: Derogatory information such as late payments, unpaid bills and bankruptcies.

RENTAL HISTORY: References from current or previous landlords and/or court eviction action information.

CRIMINAL HISTORY: Criminal activity, history of endangering others and/or history of damaging property.

Rental Policies
- Our company philosophy centers on providing you with a decent & well-maintained residence.
- We encourage our tenants to communicate/advise of any item(s) that may need attention/maintenance. We will then make our best effort to correct the item(s) in a timely manner.
- We require an $800.00 security deposit + $200.00 pet deposit (if applicable), paid prior to moving in.
- We background check all of our prospective tenants.
- We have a pet policy, which allows only a small, well-trained dog (under 10 lbs and/or a neutered/spayed cat.
- We have a crime-free/drug-free policy. We do not tolerate crime or drug activity in or around our properties.
- You are required to maintain the lawn and sidewalks as part of your lease.
- You are required to keep the property in a clean and garbage-free condition.
- We have an initial (6) month lease term, followed by month-to-month terms. This provides flexibility for both parties in the event you are dissatisfied with the property after initial term and/or we are dissatisfied with you as a tenant.
- Your rent is due in full on the 1st of every month. There will be a late fee of $40 assessed for late payments arriving in our office (after the 5th of the month If your rent is not received before the 15th of the month, eviction process will be started and you will be asked to vacate prior to the 1st of the following month. IF YOU HAVE A HISTORY OF LATE PAYMENT OR FEEL YOU CAN'T PAY YOUR RENT ON TIME, WE ARE NOT A FIT FOR YOU.
- We require a written 30 day notice (from the 1st of the month) to terminate your lease and vacate the property.
- We respect your privacy and will provide advance notice prior to making any visits to provide maintenance.
- Upon acceptance of you as our tenant, we require your security/damage & pet deposit to hold the property.
- Upon acceptance of you as our tenant, you will be provided with a Tenant Information Packet covering the above points.
Medallion Management reserves the right to make discretionary decisions regarding acceptance or denial of the applicant. Failure to qualify in one area may not automatically disqualify applicant. In this case, an extra deposit or guarantor may be required. A prospective tenant who provides false information or omits material information requested is liable for damages, plus a civil penalty of up to $500. civil court filing costs, and reasonable attomey's fees.

I have read and understand the above statements.
Applicant Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

One Application For Each Adult

Property Information

Applicant Information

Address History

Employment History

List All Occupants

Additional Information

Release

Rental Policies