Bitter Creek Leasing - Online Rental Application
 
Date 12/10/2018 6:13:27 AM
Personal Information
Your Full Name:  
Your Maiden Name:  
Telephone:  
Social Sec. No:  
Driver's License No:  
Present Address:  
City:  
  State:  
Prior Address:  
City:  
  State:  
How long have you lived at present address?  
How long have you lived at prior address?  
Nearest Relative (NOT living with you):  
Nearest Relative Address:  
Nearest Relative City:  
  State:  
Parents Name:  
Parents Address:  
Parents City:  
  State:  
Name of Landlord:  
Telephone:  
Prior Landlord:  
Telephone:  
How many will be living in this unit?   Adults:   Children:   Pets:   Weight of Pets:
Employer:  
Occupation:  
Current Monthly Salary:  
  How long?  
Contact Person:  
Employer Telephone:  
Spouse Information
Name of Spouse:  
Telephone:  
Social Sec. No:  
Driver's License No:  
Employer:  
Occupation:  
Current Monthly Salary:  
  How long?  
Contact Person:  
Employer Telephone:  
Bank Information
Bank Name:  
Bank Telephone:  
Bank Address:  
City:  
  State:  
Checking Account No:  
Savings Account No:  
Personal References
Name:   Relationship   Telephone:
Credit References
Credit Grantor:   Address   Telephone:
Other Information
Number of Vehicles (including company cars):  
Make/Model   Year   Color   Tag No.   State
       
       
       
Have you ever:
 Yes    No   Filed for Bankruptcy?
 Yes    No   Been served an eviction notice or been asked to vacate a property you were renting?
 Yes    No   Willfully or intentionally refused to pay rent when due?
 Yes    No   Been sued for unlawful detainer?
If you answered yes to any of the above, please explain:
 
How were you referred to us?
Rental Unit applied for:  
Commencement Date:  
Term:  
Rent/Month:  
 
I understand that Bitter Creek Leasing is a leasing agent for the owners of the applied property. I do hereby authorize Bitter Creek Leasing to investigate my qualifications, and release in any manner, any and all of the information obtained. I do hereby authorize any and all persons, agencies, or firms from any liability resulting from providing such information.
 
I do hereby declare under penalty of perjury that the information that I have listed above it true and correct. I also understand and false or incorrect information is grounds for rejection of this application. I further understand that failure to property and fully fill in all information slots will result in the application not being considered for lease status.

 
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