Pebblewood Homes Rental Application

Driver's License Number and State

Rows	Driver's License Number	State
Driver's License Number and State

Please list ALL other proposed occupants, Birth Dates, and Relation to you

Emergency Contact Information

Rows	Name	Phone Number	Address	Relation to You
1

RENTAL/RESIDENCE HISTORY

Rows	Current Residence	Previous Residence	Prior Address
Street Address
City
State
Zip Code
Last Rent Amount Paid
Owner/Manager Name
Owner/Manager Phone Number
Reason for Leaving?
Is/Was Rent Paid in Full?
Did You Give Notice?
Were You Asked to Move?
Name(s) in Which Your Utilities are Now Billed
Dates of Residency

EMPLOYMENT HISTORY

VEHICLES

BANKING/ CREDIT HISTORY

Rows	Bank / Institution Name	Balance on Deposit or Balance Owed
Checking Account
Savings Account
Credit Card
Auto Loan

In an Emergency, who should be contacted? (Name & Phone Number)
If you become incapacitated or pass away, who should be contacted? (Name and Phone Number)
Do any of the people who would be living in the home smoke or vape?
How long do you think you would be renting from us?
When would you be able to move in?
Have you ever been served a late rent notice?
Have you ever been served a eviction notice? If so, when and why?
Have you ever filed for bankruptcy? If so, when and why?
Have you ever been convicted of a felony? If so, when and why?
How many animals do you have (list type, Breed, Approx. Weight, and Age)? I(Including but not limited to Service or Emotional Support Animals)
Have you had any recurring problems with your current apartment or landlord? If yes, please explain:
Why are you moving from your current address?
List any verifiable sources and amounts of income you wish to have considered.
If you were to run into financial difficulty in the future and you couldn't come up with the money to pay the rent, do you know someone that would loan you the money? If so, provide the person's name, address, and phone number so that we can use them as a reference for you.
Have you ever been a party to a lawsuit in the past? If yes, please explain why:
We will run a credit and criminal background check. Is there anything negative we will find that you want to comment on?
How did you hear about this home?

I authorize Jamila Management Services to charge $ App fee, the amount listed for No. of applicants person(s), to the credit card provided herein for the NON-REFUNDABLE application fee. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.

Signature
I further understand that there is a nonrefundable fee to cover the cost of processing my application, and that I am not entitled to a refund even if I am not approved. Any questions regarding rejected applications must be submitted in writing and accompanied by a self-addressed stamped envelope.
I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for housing rental and does not constitute a rental or lease agreement in whole or in part.
I certify that the statements I have made are true and correct, and that I have the legal capacity to enter into a contract. I hereby authorize you to obtain information from others to investigate my credit, employment, income history, and criminal background, including, but not limited to, information I provided and communications with any names listed on this application. I agree that you may report information regarding my account to consumer reporting agencies.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

PERSONAL INFORMATION