HOLLEY PROPERTIES
RENTAL APPLICATION FORM
Page 1 of 4
First: Middle: Last:
Social Security #: Birthdate:
Home Phone: Cell Phone:
Drivers License Number: State:
Present Address:
City: State: Zip:
Resided here for how long? Monthly Rent/Mortgage:
Present Landlord: Phone #:
Reason for leaving:
Previous Address:
City: State: Zip:
Resided here for how long? Monthly Rent/Mortgage:
Previous Landlord: Phone #:
Reason for leaving:
Present Occupation: For how long?
Company Name:
Address:
Owner/Supervisor:
Company Phone #: Supervisor Phone #:
Current Gross Income Per Month (Before Deductions): $
Sources of income in addition to present employment listed above (optional):
Savings Account (Bank): Acct. #:
Checking Acct: (Bank): Acct #:
Major Credit Card: Acct #:
Have you ever failed to pay rent when due? If yes, when?
Have you ever filed Bankruptcy? If yes, when?
Have you ever been evicted? If yes, when?
Do you have any pets? Describe:
Do you have a waterbed: Do you or anyone living with you smoke?
Number of Vehicles owned: Makes:
Name and relationship of everyone living with you. (Include ages of minor children.)
In the event of an Emergency contact (family or friends NOT living with you):
Name: Phone:
HOLLEY PROPERTIES
RENTAL APPLICATION FORM
Page 2 of 4
First: Middle: Last:
Social Security #: Birthdate:
Home Phone: Cell Phone:
Drivers License Number: State:
Present Address:
City: State: Zip:
Resided here for how long? Monthly Rent/Mortgage:
Present Landlord: Phone #:
Reason for leaving:
Previous Address:
City: State: Zip:
Resided here for how long? Monthly Rent/Mortgage:
Previous Landlord: Phone #:
Reason for leaving:
Present Occupation: For how long?
Company Name:
Address:
Owner/Supervisor:
Company Phone #: Supervisor Phone #:
Current Gross Income Per Month (Before Deductions): $
Sources of income in addition to present employment listed above (optional):
Savings Account (Bank): Acct. #:
Checking Acct: (Bank): Acct #:
Major Credit Card: Acct #:
Have you ever failed to pay rent when due? If yes, when?
Have you ever filed Bankruptcy? If yes, when?
Have you ever been evicted? If yes, when?
Do you have any pets? Describe:
Do you have a waterbed: Do you or anyone living with you smoke?
Number of Vehicles owned: Makes:
Name and relationship of everyone living with you. (Include ages of minor children.)
In the event of an Emergency contact (family or friends NOT living with you):
Name: Phone:
HOLLEY PROPERTIES
RENTAL APPLICATION FORM
Page 3 of 4
Company Name: Acct #:
Phone #: Balance due: Monthly Payment:
Company Name: Acct #:
Phone #: Balance due: Monthly Payment:
Company Name: Acct #:
Phone #: Balance due: Monthly Payment:
Name: Phone:
Address:
How long have you known this person? Related to you?
Name: Phone:
Address:
How long have you known this person? Related to you?
Company Name: Acct #:
Phone #: Balance due: Monthly Payment:
Company Name: Acct #:
Phone #: Balance due: Monthly Payment:
Company Name: Acct #:
Phone #: Balance due: Monthly Payment:
Name: Phone:
Address:
How long have you known this person? Related to you?
Name: Phone:
Address:
How long have you known this person? Related to you?
Please note: There is a $25.00 non-refundable fee for each adult that must be returned with this rental application form. This fee covers the credit agency processing and must be paid in the form of a personal bank money order or a cashier’s check in order for your application to be processed quickly. A personal check can also be used for payment. However, your application will not be processed until the personal check clears the bank (usually 2-3 days). All rental applications will be reviewed by the Landlord in the order returned from being processed by the credit reporting agency.
Please make your payment payable to Holley Properties and mail this entire application form to:
Holley Properties
P.O. Box 383
Holmen, WI 54636
Fax: (608)-526-4713
GENERAL RELEASE
RENTERS AUTHORIZATION / CERTIFICATION
Page 4 of 4
Landlord: Holley Properties
Daryl Holley
P.O. Box 383
Holmen, WI 54636
Phone: (608) 526-9097
Fax: (608) 526-4713
To Whom It May Concern;
I/We hereby authorize verification of references given and authorize you to release to any credit reporting agency for verification purposes, information concerning:
Employment history, dates, title, income, hours worked, etc;
Banking and Savings account records;
Rental history, payment amounts, payment record;
Any information deemed necessary in connection with a consumer credit report.
The Landlord may share information bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living with its affiliates unless I direct the Landlord at the address above that such information, if unrelated to my transactions or experiences with the Landlord, may not be shared by the Landlord with its affiliates.
This information is for the confidential use in compiling a credit report for a Landlord I am leasing, or may be leasing, property from.
A photographic, facsimile, or carbon copy of this authorization may be deemed to be the equivalent of the original and may be used as a duplicate original.
All parties signing this authorization are affirming their intent to apply for joint credit. A single signature implies intent for individual credit.
All parties signing this authorization declare the information provided is true and correct.
Your prompt reply will help my real estate transaction. Thank you.
Dated this day of , 20 .
Signed SS#
Print Name here:
Signed SS#
Print Name here:
| Copyright 2006 by Viking Realty, Inc. All rights reserved. |
| vikingrealty@vikingrealty.us |
| 605 Holmen Dr. |
| P.O. Box 517 |
| Holmen, WI 54636 |
| Phone: (608) 526-3344 |