Application

KAC Realty, LLC or Andy Clark
PO Box 16694, Greensboro, NC 27416
Office - 674-6203 E-mail: kacrealtyllc@hotmail.com Fax - 674-9909

Application to Lease

Required to Continue*

I have made an appointment and viewed the inside of the home

Unit Address

Date

MonthDayYear

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail

Marital Status

Birthdate

First and Last Names of All Living in the home *

Please list the full names all occupants

Current Address

Landlord Name and Telephone #

How long at this address

Current Rent Amount

Why are you moving?

Have you ever been evicted and/or are you currently in the process of being evicted?

YesNo

If yes, when?

Whose name will the utilites be in?

When would you like to move in?

MonthDayYear

When will you have the deposit?

MonthDayYear

Emergency Contact

First NameLast Name

Emergency Contact

Area CodePhone Number

Employment Data: Applicant

Proof of Income is required.

Employer

Address

Contact

Position

Gross Monthly Income

Date Employed

Other Income, please explain

Employment Data: Co-Applicant

Proof of Income is Required.

Employer

Address

Contact

Position

Gross Monthly Income

Date Employed

Other Income, please explain

I/We am/are authorizing the Owner/Manager to investigate in its discretion employment, personal and credit references, prior evictions and any other items of information set forth in this application.

If any information on this application is found to be false, it will be grounds for refusal to rent or to continue renting from us and you agree to waive a refund of any money paid, and you agree this paragraph overrides any provision of any Lease Agreement, written or verbal.

I/We agree that if this application is accepted and I/we do not take the unit for which the hold fee was paid, the hold fee will not be refunded or transferred. The hold fee will be used as the security deposit once the lease is signed.

Applicant*

Co-Applicant

Once your application is received we will contact you with the documents needed to process the application. If you do not hear from us within 2 business days please reach out - kacrealtyllc@hotmail.com or call and leave a message - 336-674-6203.