Market Rental Application

Unit Applying For

Property Address

523 Lamont St NW #22

Full Name

Reginald F. Lewis

Applicant Type*

Personal Information

Alias Used (If Applicable)

Phone

Email

Birth Date

Social Security Number*

555-22-555

Please upload an image of your ID or Drivers License*

Max. file size: 100 MB.

Please upload your two most recent paystubs/Offer Letter/Proof of Income

Drop files here or

Max. file size: 100 MB.

Marrital Status

Married Since

Current Spouse Name

First Last

Divorced Since

Former Spouse Name

First Last

Rental History

Current Address*

Street Address City State ZIP Code

Total Contract Rent $

Owner/Management Name

Email

Phone

Since*

Is Your Rent Up To Date?*

Please explain*

Why are you leaving?

Have you given notice?

Have you been asked to leave?*

Did the Owner/Management issue you a 30 Day Notice to Correct/Cure or Vacate?

Please explain why

Former Address*

Street Address City State ZIP Code

Length Of Stay

4/29/95-7/22/18

Total Contract Rent $

Email

Former Owner Management name

Phone

Was your rent up to date?

Please explain

Reason for leaving

Did you give a notice?

Were you asked to leave?

Did the Owner/Management issue you a 30 Day Notice to Correct/Cure or Vacate?

Please explain..

Occupants

Name

First Last

Relationship

Birthdate

Name

First Last

Relationship

Birthdate

Name

First Last

Relationship

Birthdate

Name

First Last

Relationship

Birthdate

Name

First Last

Relationship

Birthdate

Pets

DISCLAIMER: All pets must be authorized by BREH, in writing, prior to occupying the rental unit. Any tenant found with an unauthorized pet will be subjected to an immediate 30 Day Notice to Correct or Vacate and will be penalized a fee not to exceed $2,000.00.

Do you have pets?

Total Pets

Type/breed & size/weight

Car

Vehicle

Make/Model/Year/Color

License Plate #

State

Employment

Current Employer

Dates Emplyoyed

7/22/18-Present

Street/City

11th St NW/Washington D.C

Position

Gross Annual Income*

Supervisor

Weekly Work Hours

Employer’s Phone #

Employer’s Email

Past Employer

Dates Previously Emplyoyed

9/12/13-7/22/18

Supervisor

Street/City

11th St NW/Washington D.C

Position

Annual Income

Weekly Work Hours

Phone

Email

Reference

Non-Relative Reference

First Last

How are you acquainted?

Phone

Emergency Contact

First Last

How are you acquainted?

Phone

Credit Accounts

1)

Citibank Credit Acct

Montly Payment Amount

$555

Are You Current?*

2)

Citibank Credit Acct

Montly Payment Amount

$555

Are You Current?*

3)

Citibank Credit Acct

Montly Payment Amount

$555

Are You Current?*

4)

Citibank Credit Acct

Montly Payment Amount

$555

Are You Current?*

Has any signer ever sued for bills?

Has any signer everfiled for bankruptcy?

Has any signer ever been sued for eviction?

Has any signer ever broken a lease?

Has any signer ever been guilty of a felony?

Are you or any person who will occupy the rental unit currently under the supervision of a parole or probation officer?

Parole Officer/Probation Officer Name

Phone

Has any signer or any person who will occupy the unit a registered sex offender?

Date and location of registeration

Authorization and Certification

1)I, the undersigned applicant, authorizes Bailey Real Estate Holdings LLC (hereinafter known as “BREH”) to contact past and present landlords, employers, creditors, credit bureau, neighbors and any other sources deemed necessary to investigate me. All the information is true, accurate and complete to the best of my knowledge. I am aware that BREH reserves the right to disqualify me if the information is not as represented. 2)I, the undersigned applicant, certify under penalty of perjury, that all information provided is correct and complete and hereby authorize BREH to conduct a credit check, background check and make any inquiries BREH feel necessary to evaluate my tenancy and credit standing. I understand that giving incomplete or false information is grounds for rejection of this application. I am aware that if any information is supplied on this application is later found to be false, this is grounds for termination of tenancy. The applicant has the right to dispute the accuracy of any information provided to BREH by the screening service or credit reporting agency.

Rental Verification Authorization (Please Initial Below)*

DISCLAIMER: In the event BREH is unable to obtain written or verbal rental verification from your current and/or previous landlord within 5 business days after initiating the request, BREH reserves the right to disqualify you on the grounds of not being able to fully process your application.

Hold Harmless and Indeminification (Please Initial Below)*

HOLD HARMLESS AND INDEMNIFICATION: I, the undersigned applicant, declare that I shall indemnify and hold harmless BREH, its agents, successors and/or assigns from and against all claims, causes of action, damages, losses, and expenses including but not limited to attorney’s fees, legal cost, and expenses arising out of, or resulting from any legal matters associated or may arise out of BREH’s disqualification and/or denial of my rental application.

Please Write Your Full Name Below*

ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME.

Date of Completion

Additional Comments