Application

T he undersigned hereby applies for___________________________________________________________

Date and Signature of person receiving application_____________________________________________

PLEASE TELL US ABOUT YOURSELF

FULL NAME________________________________________________________________________________

Date of Birth______________________________SS#_____________________________________________________________

Name of Co-Applicant___________________________SS#_______________________________________________________

Other Occupants/roommates______________________________________________________________________________

# of Dependents (excluding Co-Applicant)____________________________# of Pets___________________

PLEASE GIVE YOUR RESIDENCE HISTORY FOR THE PAST 3 YEARS (BEGIN WITH THE MOST CURRENT)

CURRENT ADDRESS (INCLUDING ZIP CODE)_________________________________________________________________

Month & Year Moved in______________ Reason for Leaving______________________________________________

Person to Contact____________________________________________ Phone( )____________________________

PREVIOUS ADDRESS (within 3 years)_______________________________________________________________________

Month & Year Moved in______________ Reason for Leaving______________________________________________

Person to Contact____________________________________________ Phone( )____________________________

PLEASE GIVE YOUR EMPLOYMENT INFORMATION

YOUR STATUS: ___Employed Full Time ___Employed Part-Time ___Student ___Retired ___Unemployed

EMPLOYER____________________________________________ Date(s) employed____________________________________

Employed as________________________________________________ Telephone ( )________________________________

Supervisor__________________________________________________ Salary $_______________________________________

CO-APPLICANT EMPLOYER AND TELEPHONE NUMBER____________________________________________________________

Supervisor's name and Salary_____________________________________________ Salary $____________________________

PLEASE LIST THE FOLLOWING

Your Driver's License Number _____________________________________ State______________________________________

Co-applicant Driver's License Number______________________________ State______________________________________

Your Vehicle Make/Model, Year and License #____________________________________________________________________

Second Vehicle information____________________________________________________________________________________

HAVE YOU EVER: Filed for bankruptcy? ___No ___Yes Been evcted from tenancy? ___No ___Yes

Please give any additional information which might help management evaluate this application:

_____________________________________________________________________________________________________________

For any questions we may have, please give PHONE NUMBERS WHERE YOU CAN BE LOCATED:

Daytime________________________________________ Night-time_________________________________________

I hereby apply to lease the above described premises for the term and upon the conditions above set for forth and agree that the rent is to be payable on the 1st day of the month in advance. As an inducement to the owner of the property and to the agent to accept this appliation, I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, $______ of the deposit will be retained to offset the agents's cost, time, and effort in processing my appication.

I hereby deposit $_____ as earnest money to be refunded to me, less $_____ for cost, time, and effort of the agent, if this application is not accepted. (Cost, time and effort includes the following: 1. time to process application including telephone calls; 2. credit report fees; and 3. looking at prospective tenants residence, if out of state this is done by an appraiser).

Upon acceptance of this appiation, this deposit shall be retained as the security deposit. When so approved and accepted I agree to execute a lease for _____ months before possession is given. Also, upon acceptance, I understand that $200.00 of by deposit will be retained as a tenant initiation fee. This is for the above mentioned costs and for all other costs in executing a lease.

I understand that if I am found to be qualified to rent the property applied for, and I decline to rent the property after being notified of such qualification, my deposit will be refunded, less the daily rental rate for each day that elapses from the date I am notified through the date I decline to rent the property, taken as liqudated damages. The daily rate for the property I have applied for is $______.

BY SIGNING BELOW, I AUTHORIZE PARKER PROPERTIES TO MAKE INQUIRIES THROUGH THE CREDIT BUREAU OR FROM MY EMPLOYER AND OTHER REFERENCES THAT I HAVE SUPPLIED AND THAT A PARKER PROPERTIES AGENT OR AN APPRAISER WILL WALK THROUGH MY CURRENT RESIDENCE. I UNDERSTAND THAT I HAVE THE RIGHT TO MAKE A WRITTEN REQUEST WITHIN A REASONABLE PERIOD OF TIME TO RECEIVE ADDITIONAL, DETAILED INFORMATION ABOUT THE NATURE AND SCOPE TO THIS INVESTIGATION.

The above information, to the best of my knowledge, is true and correct.

Signature of Applicant_____________________________________________________ Date_________________________

APPLICANT: DO NOT WRITE BELOW THIS LINE

Deposit of $_______________ Received by _______________________________________________________ Date______________

VERIFICATION OF APPLICATION AND COMMENTS

______________________________________________________________________________________________________________

This Application is _____APPROVED _____NOT APPROVED By_____________________________

Applicant Notified By____________________________________ Date____________________________________