Rental Application Form

First Name

Last Name

Email

Phone Number

Date of Birth Please format as mm/dd/yyyy

Last Four of SSN ###-##-_ _ _ _

Address Line #1 Ex. 123 Alphabet Drive or NONE

Address Line #2 Ex. Ste 17

City / District Ex. Parkersburg or NONE

State / Province Ex. Ohio or NONE

Postal Code Ex. 12345 or NONE

Country Ex. United States or NONE

Current Employer

Job Position

Time in Current Position Ex. 1 Year, 2 Months, if applicable...

Pay Rate and/or Annual Income Ex. 25/hr or $72,000, if applicable...

Amount of Monthly Income Derived From Other Sources

Other Occupants (Name and Age) - If Applicable Ex. Judy Shoe, 12; Mike Wilheilm, 14

Pets (Age, Breed, and Weight) - If Applicable Ex. 12, German Shepherd, 35lb; 6, Poodle, 10lb; 7, Devon Rex, 5lb

Has Any Household Member Declared Bankruptcy in the Last Seven Years? Has Any Household Member Declared Bankruptcy in the Last Seven Years? Yes No

If a Household Member Has Been Evicted From a Rental Property, Explain Why

If a Household Member Has Been Late on Two or More Rental Payments in the Last Year, Explain Why

If a Household Member Has Been Convicted of a Felony in the Last 10 Years, Explain Why with the Year and Nature of the Charge

Please Provide Three Personal References (Name, Phone Number, Relationship)

Is there anything else you would like to tell us that could better help us to process your application

I/we, the undersigned, authorize A&S Consulting Firm LLC and its agents to obtain an investigative consumer credit report if needed including but not limited to credit history, OFAC search, landlord/tenant court record search, criminal record search and registered sex offender search. I authorize there lease of information from previous or current landlords, employers, and bank representatives. This investigation is for resident screening purposes only, and is strictly confidential. This report contains information compiled from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold A&S Consulting Firm LLC, Landlord and its agents free and harmless of any liability for any damages arising out of any improper use of this information. I/We the undersigned applicants hereby certify that the information provided above is true, accurate and complete and we understand and acknowledge that the owner of the premises
I/we are applying to rent, if he or she enters into a lease agreement with me/us, does so in
reliance on the truth, accuracy and correctness of the above said information. I/We agree to
vacate said premises, at said owner’s or said owner’s agent’s request, immediately if any of the above information is found untrue, inaccurate or incorrect. By inserting my/our first and last name(s) above, I/we acknowledge that I am/we are providing my/our legally binding signature(s).SaveClear

Date of Signing *