Credit App Payment Form

PAX REAL ESTATE
CREDIT APPLICATION PAYMENT FORM
$40 PER APPLICANT
NOTE: A Residential Rental Application OR a Commercial Lease Application should be completed prior to making a payment.
Full Name *

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State

Zip Code Country
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 in my Rental/Lease Application (submitted separately). I further authorize a credit check to be performed through a credit reporting agency in accordance with the terms & conditions of this application.
Signature
Should be Empty:

Electronic Signature