Rental Application

 

LEACH REALTY INC.

3015 S CHURCH ST

BURLINGTON NC 27215

WEST PARK CENTER

(336)524-9922 (866)459-2573e-Fax

RENTAL APPLICATION

 

Neatly complete all information below. All applicants over the age of 18 must complete and sign their own application.

 

Applicant’s full name___________________________________Phone___________________DOB__________

Social Security____________________DriversLicense____________________State________Exp.________

 

Co-Applicant’s fullname___________________________________Phone___________________DOB_______

Social Security____________________DriversLicense____________________State________Exp.________

 

CurrentAddress________________________________City___________________State________Zip_________

Current Landlords Name__________________________________

 Phone _____________________How long at this address__________

Reason for leaving______________________________________________

 

PreviousAddress________________________________City___________________State_______Zip_________

Previous Landlords Name__________________________________________

Phone ______________________

How long at this address__________

Reason for leaving______________________________________________

INITIAL________________

 

 

Present Employer _____________________________Position__________________

Phone #__________________How long at job_________

Other income/source____________________________

Employers Address_________________________________________City___________________State________

Number and type of Pets_ __________________________

Have you ever been party to an eviction? [ ] Yes [ ] No                                                                                                                      

                                                                                                                                                                    

Personal/ Business References

Name ______________________________Yrs. Known____ Relationship_ ___________

Phone#______________

Name ______________________________ Yrs.  Known_ ___Relationship____________

Phone#______________

Name______________________________ Yrs. Known ____Relationship ____________

Phone    #______________

Total number of adults __________Total number of children living with you under the age of18 age__________

Names and relations of all other applicants_________________________________________________________

___________________________________________________________________________________________

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize

Investigation of all statements contained in this application for tenant screening as may be necessary in

Arriving at a tenant decision, I understand that the landlord may terminate any rental agreement entered

Into for any misrepresentations made above.

Signature_________________________________________________Date________________

 

Signature_________________________________________________Date________________

 

Received from applicant the non-refundable sum of $___dollars to pay for tenant screening service

Translator
Contact Info
Agent
Laura Leach

Broker/Owner

Leach Realty

3015 S Church St West Park Center
Burlington  North Carolina 27215

336-524-9922 336-442-9797