Rental Application

CONSUMER NOTICE

ROCKWEL REALTY HEREBY STATES THAT WITH RESPECT TO THIS PROPERTY,

THEY ARE ACTING AS THE OWNER/LANDLORD.

RENTAL APPLICATION

Property Address____________________________________________________

Monthly Rent _____________________Deposit___________________________

Utilities paid by tenant: Gas q Electric q Water/Sewage q Garbage q

Application fee: $35.00 payable to Rockwel Realty

Not refundable if approved, rejected or cancelled.

Applicant shall forfeiture the security deposit under the following condition: Failure of the applicant to enter into a lease agreement with the Lessor upon acceptance of the applicant(s) as a tenant by the Lessor, and after being duly notified of such acceptance within forty-eight (48) hours of such notification to enter into a lease agreement.

In the event the applicant(s) is/are not accepted as a tenant(s) the security deposit will be refunded.

AUTHORIZATION: Applicants authorize Landlord or Broker to obtain any information deemed necessary to evaluate this Application. This information may include, but is not limited to, credit reports, criminal history, judgments of record, rental history, verification of employment and salary, employment history, vehicle records and licensing records. Applicants acknowledge that all information in the Application is true and correct and that they have received the Consumer Notice as stated above. Applicants acknowledge that if they present false or incomplete information, Landlord may reject this Application and Applicants may forfeit any payments made in connection with this Rental Application.

Applicant Signature ___________________________________________date__________

Co-Applicant Signature ________________________________________date__________

Vehicle Information

Make/Model__________________________________________________________________

License Plate __________________________________________________________________

Applicant Information

Name ______________________________________________________________________

Social Security Number _________________ Date of Birth ___________________

Phone # _______________________________________________

Email Address __________________________________________

Present Address ___________________________________________________________

Current Monthly Rent $ _____________ Time at this address _____________________

Landlords Name_________________________ Phone ___________________________

Have you ever been served with an eviction notice? _________

Has any landlord filed a complaint against you? ___________

Employment Information

Employer ____________________________________________

Phone # ______________________________________________

Monthly Salary $____________ Position________________________

Employed Since ___________

Emergency Contact & Relationship

___________________________________________________________________________

Address ___________________________________________________________________

Phone _____________________________________________________________________

Co-Applicant Information