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1. Name: Age: Relationship:
Occupation/School:

2. Name: Age: Relationship:
Occupation/School:

3. Name: Age: Relationship:
Occupation/School:

Present Address
Street:
City, State:
ZIP:

Type of Housing? (Student housing, parents, own the home, renting, leasing)


Reason for moving:

If your present address is a rental property, complete the following
Monthly rent:
How long?
Breaking Lease?
Owner or Agent:
Agent's Address:
Agent's Phone:

Previous Addresses (Last three years)
From/To: to
Street:
City, State: ZIP:

From/To: to
Street:
City, State: ZIP:

Financial Information
Present Employer: How Long?
Address:
Occupation: Salary:
Phone: Supervisor:

If you've been at the current job less than two years, please list previous employers:


Other source of income:
Vehicle Info - Make/Model/Year:
License Plate #: State:
Driver's License #: State:


Personal Reference: Phone:
Emergency Contact: Phone:

Have you ever:
A. Been evicted?
B. Taken to court by current or prior landlord?
C. Failed to pay rent timely?
D. Filed bankruptcy?

If yes to any of the above, please explain:


Terms and Conditions
Any false or misleading statement on this application shall be considered grounds for lease termination.

Authorization to obtain information: applicant hereby authorizes Lessor to verify accuracy of all statements in the application and also authorizes all employers, previous landlords, mortgage holders, all banks and any other creditors listed on the application to release all information concerning me or my accounts, my rental history or payments, my employment history, including the likelihood of future employment, for the purpose of verifying the application and determining my ability to afford the contractual obligations of the lease.

The above authorization entitles Lessor to check applicant’s credit at the credit bureau.A photocopy of the above authorization shall be the equivalent of the original.

This authorization shall be continuing during the term of the lease or any renewal of the lease; to update or otherwise verify new information including, but not limited to Lessor’s rights, to inquire from time to time from banking institutions, whether there are sufficient funds to pay check(s) delivered by Lessee to Lessor.

By signing my signature to this application, I hereby verify that I am the person who I represent myself to be, I am the person who will occupy the premises and I am not falsely making application on behalf of another party/parties who would be considered illegal occupants of said premises. Applying for this apartment/home on behalf of another person is fraudulent and will be considered grounds for rejection and/or eviction, if applicable. All the information, which I have provided, is true and accurate.

Agent’s Disclosure
I/We understand that The Octavia Hill Agent is an agent of the owner and is a paid representative of the owner.
I/We acknowledge that this written notice was received before I/We received a lease agreement.
No pets/animals are permitted to be on the premises fat any time for any reason. No waterbeds are permitted.

If approved for this or any rental unit which was built prior to 1978, I agree to sign an acknowledgement that the Lessor and or Lessor’s agent has provided me with recommendations stipulations regarding lead paint hazard.

I have read these Terms and Conditions
I agree to these Terms and Conditions


Name: Date:
E-mail: