Website Residential Rental Application-W/LINK TO PAYPAL PAYMENT FORM

PAX REAL ESTATE

RESIDENTIAL RENTAL APPLICATION
Rental Property Address:

Street Address

Street Address Line 2

City State

Zip Code Country
PAX Agent's Name (please select)
Anticipated Move-In Date

Month Day Year
PERSONS FINANCIALLY RESPONSIBLE FOR RENT
List all persons who will be financially responsible for monthly rent.
Applicant #1 - Person Primarily Responsible for Monthly Rent:

First Name Middle Name Last Name Suffix
Applicant #2 - Second Person Primarily Responsible for Monthly Rent. NOTE: PLEASE COMPLETE A SEPARATE APPLICATION

First Name Middle Name Last Name Suffix
Applicant #3 - Third Person Primarily Responsible for Monthly Rent. NOTE: PLEASE COMPLETE A SEPARATE APPLICATION

First Name Middle Name Last Name Suffix
APPLICANT INFORMATION
NOTE: EACH PERSON WHO WILL BE FINANCIALLY RESPONSIBLE FOR RENT MUST SUBMIT A SEPARATE RENTAL APPLICATION AND PAY A SEPARATE CREDIT REPORT FEE OF $40.
Full Legal Name

First Name Middle Name Last Name Suffix
Birth Date

Month Day Year
Primary Phone Number

Area Code Phone Number
Secondary Phone Number

Area Code Phone Number
Email
example@example.com
Driver's License #
Social Security #
TOTAL # of Occupants
# of Children
Age Range of Children

From To
Any Pets?

Yes No
# of Pets
Type of Pet

Dog Cat Other
Type of Pet (if Other)
Have You Ever Been Convicted of a Felony?

Yes No
If yes, please explain
RENTAL HISTORY
Present Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Present Landlord Name
Phone Number

Area Code Phone Number
How Long There?
Reason for Leaving?
Previous Address (if less than 2 years ago)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Previous Landlord Name
Phone Number

Area Code Phone Number
How Long There?
Reason for Leaving?
EMPLOYMENT INFORMATION
Current Employer
Position Title
Start Date

Month Day Year
Gross Monthly Income
Employer Phone Number

Area Code Phone Number
Current Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
PREVIOUS EMPLOYER (if less than 2 years in current position)
Previous Employer
Position Title
Start Date

Month Day Year
Gross Monthly Income
Employer Phone Number

Area Code Phone Number
Previous Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
BANK INFORMATION
Bank Name
Bank Phone Number

Area Code Phone Number
Account Type
Bank Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
PERSONAL REFERENCES
First Reference

First Name Last Name
1st Reference Phone Number

Area Code Phone Number
Relationship to Applicant
Second Reference

First Name Last Name
2nd Reference Phone Number

Area Code Phone Number
Relationship to Applicant
EMERGENCY CONTACT
Full Name

First Name Last Name
Phone Number

Area Code Phone Number
ELECTRONIC SIGNATURE
I hereby authorize PAX Real Estate (or its representative) to contact any references that I have listed and to verify all information contained herein.
Signature

Clear
IT IS RECOMMENDED THAT YOU PRINT THIS FORM PRIOR TO CLICKING ON THE "SUBMIT" BUTTON. THIS WILL ENSURE THAT ALL DATA WILL BE SAVED AND AVAILABLE TO YOU IF IT IS NEEDED AT A LATER TIME.
**PLEASE NOTE: There is a $40 application fee required for EACH applicant.**

Payment may be made using this form once your application has been reviewed by your Agent.
Should be Empty:

PERSONS FINANCIALLY RESPONSIBLE FOR RENT

APPLICANT INFORMATION

RENTAL HISTORY

EMPLOYMENT INFORMATION

PREVIOUS EMPLOYER (if less than 2 years in current position)

BANK INFORMATION

PERSONAL REFERENCES

EMERGENCY CONTACT

ELECTRONIC SIGNATURE