RENTAL APPLICATION

NAME _____________________________________________________________________________

SSN _______________________________________________ D.O.B. ________________________

CURRENT ADDRESS ________________________________________________________________

HOW LONG AT THIS ADDRESS _______________________ years or months (check one)

PREVIOUS ADDRESS__________________________________________________________________________

HOW LONG AT THIS ADDRESS_______________________ years or months (check one)

PHONE ________________________________________ CELL: _____________________________

NAME OF CURRENT LANDLORD _____________________________________________________

NAME OF PREVIOUS LANDLORD IF LESS THAN 2 YEARS _______________________________

CURRENT EMPLOYER _______________________________PHONE ________________________

LENGTH OF TIME WITH EMPLOYER ___________________ years or months (check one)

PREVIOUS EMPLOYER ______________________________PHONE_________________________

LENGTH OF TIME WITH PREVIOUS EMPLOYER __________ years or months (check one)

GROSS MONTHLY INCOME FROM EMPLOYMENT ______________________________________

OTHER INCOME & SOURCE_________________________________________________________

PERSONS OCCUPYING THE PROPERTY______________________________________________

DESCRIPTION OF PETS IF ANY ______________________________________________________

PROPERTY MANAGER/ WAYNE CUNDIFF/ PARK PLACE REALTORS INC.
445 Elm Ave. SW
ROANOKE, VA. 24016
PHONE: (540) 342-1010 EXT. 17 FAX (540) 342-7070

I AUTHORIZE PARK PLACE REALTORS INC. TO OBTAIN A CREDIT REPORT AND TO MAKE INQUIRIES FOR REFERENCES OF EMPLOYMENT AND TENANCIES.

SIGNATURE: ______________________________________________________ DATE: ______________________________

$15 APPLICATION FEE SUBMITTED WITH APPLICATION