870-862-5435 315 NORTH WEST AVE.
EL DORADO, ARKANSAS

Rental Application

About You

DOB:^*

Email:^*

Phone:^*

Mobile Phone:

Work Phone:

Home Information

What size home are you interested in?

Number of Bedrooms:

Number of Bathrooms:

Price Range:

If you are interested in a specific house(s), plase list:

List all other occupants (Name and Date of Birth):

Number of Outside Pets:

Number of Inside Pets:

Describe pets:

Rental History

Do you, or will you, receive rental assistance? Yes No

Have you or any other household member ever broken a lease or been evicted? Yes No

If yes, please explain:

Have you or any other household member ever been convicted of a drug-related crime? Yes No

If yes, please explain:

Have you or any other household member been convicted of a felony? Yes No

If yes, please explain:

Have you or any co-applicant experienced a bankruptcy or foreclosure? Yes No

If yes, please explain:

Residency History

List your residency history for the last 3 years beginning with the most current address.

Current Address:

Previous Address:

Automobiles

Tell us about your automobiles.

Employment

List all verifiable income of every household member (including SSI and Retirement).

Employer Name, Supervisor Name, Phone Number

Emergency Contact

Please list an emergency contact, which in the event of an accident or illness is authorized to enter and remove property.

Disclaimer and Signature

I or we believe informtion listed above to be the truth and correct to the best of my or our knowledge. I agree that Landlord may terminate any agreement entered into in reliance on any misstatement made above.

I hereby authorize the Landlord or Landlord's agents to verify the information on the application. Verification or re-verification of any information contained in the application will be retained by the Landlord. I hereby authorize Tenant Data Services, Inc. to obtain information about me, including, not limited to, this application, my credit, my tenant history, my check writing history, any court records and/or my criminal record, and I hereby authorize and instruct any entity or person contacted by Tenant Data Services, Inc. or the Landloard or Landlord's agents to release such information to them. Upon request, Tenant Data will provide the name and phone number of the source of the information used in the verification process.

I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT. I AUTHORIZE ITS VERIFICATION AND THE OBTAINING OF CONSUMER CREDIT REPORT.

Applicant Signature:
Typing your name here is your electronic signature.

Co-Applicant Signature:
Typing your name here is your electronic signature.

Enter Security Code: image verification