Residential Rental Application-W/LINK TO PAYBAL PAYMENT FORM

Rental Property Address:

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. NOTE: EACH PERSON LISTED MUST SUBMIT A SEPARATE RENTAL APPLICATION AND PAY A SEPARATE CREDIT REPORT FEE OF $40.
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
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

Previous Address (if less than 2 years ago)

Current Employer Address

Previous Employer Address

Bank Address

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:

APPLICANT INFORMATION