R#__________

RENTAL APPLICATION

Please Print Clearly

Agent´s Name:_____________________________________________

Property Address:__________________________________________

Rent Amount $______________ Security Deposit $_______________

Move In Date:______________ Lease Term ____________________

Amount Rec´d.$_____________ Date:_________________________

Approval of this application requires adequate verification of the information submitted by the applicants:

Last Name             First Name                         Middle Initial                           Date of Birth

____________________________________________________________________________

Social Security Number (attach copy)              Home Phone Number          Work Phone Number

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Driver´s License Number (attach copy)                                              Marital Status

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Spouse      Last Name             First Name               Middle Initial           Date of Birth

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Social Security Number (attach copy)        Home Phone Number            Work Phone Number

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Driver´s License Number (attach copy)                                  Marital Status

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Vehicle Make Model Color Tag # State Year

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Vehicle Make Model_________ Color Tag#_______ State____ Year____

Current Residence Street Address               City           State          Zip 
________________________________________________________________________

Occupancy Dates     From __________  To__________

Comments:______________________________________________________________

Landlord Name/Address              Landlord Ph.#                              Rent Amount On Lease?
_______________________________________________________________________

From______________To______________

Previous Address______________________ City______________ State___ Zip________

Landlord Name/Address              Landlord Phone #                       Rent Amount On Lease?
_______________________________________________________________________

Please Name All Who Will Occupy The Premises:

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Name                  Age                                  Sex                               Relationship

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Name                      Age                               Sex                              Relationship

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Name                   Age                                 Sex                               Relationship

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Name                  Age                                 Sex                               Relationship

Please List Any Pets That Will Occupy the Premises(Owner Approval Must be Obtained)

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Type of Pet            Breed                  Weight                          Type of Pet      Breed       Weight

Prospective Tenant(s) Understand There is a $________ Non-Refundable Pet Fee (Minimum $200.00)    Initials__________  And a pet application

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Name/Nearest relative not living with you     Address     City     State        Phone w/area code

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Name/Nearest relative not living with you     Address     City    State        Phone w/area code

Please Provide Employment Information For Past 2 Years

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Company Name Address Phone

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Supervisor Gross Salary Dates of employment Position

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company name (previous) address phone

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supervisor name gross salary dates of employment position

Spouse Employment

_____________________________________________________________________

Company name address phone

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supervisor gross salary dates of employment position

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company name(previous) address dates of employment position

_________________________________________________________________

IS THERE ANYTHING YOU FEEL WE SHOULD KNOW THAT MAY AFFECT APPROVAL OF YOUR RENTAL APPLICATION?

_________________________________________________

REASON FOR LEAVING CURRENT RESIDENCE:__________________________________________________________

Have you ever:

Filed for Bankruptcy? yes( ) no( )

Been Evicted from Tenancy? yes( ) no( )

Willfully or Intentionally refused to pay rent? yes( ) no( )

Broken a Rental agreement of a Lease? yes( ) no( )

Been sued for non-payment of rent? yes( ) no( )

Been convicted of a Felony? yes( ) no( )

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APPLICANT(S) HEREBY AUTHORIZES DEBORAH GLOMB REALTY; TO VERIFY AND CHECK ANY AND ALL INFORMATION REQUIRED TO PROCESS HIS/HER APPLICATION FOR RESIDENCY, INCLUDING BUT NOT LIMITED TO EMPLOYMENT, BANK ACCOUNT, EVICTION, CRIMINAL BACKGROUND CHECKS AND AUTHORIZE PROPERTY MANAGER TO ONTACT ANY PERSONS OR COMPANIES LISTED ON THE APPLICATION, A CONSUMER CREDIT REPORT $_________, HIS/HER LANDLORD AND EMPLOYMENT REFERENCES. APPLICANT(S) UNDERSTANDS THERE IS A $30.00 NON-REFUNDABLE APPLICATION FEE FOR EACH APPLICATION TO BE PAID IN CASHIER´S CHECK OR MONEY ORDER BEFORE THIS APPLICATION IS PROCESSED. THIS APPLICATION FEE WILL BE RETAINED BY DEBORAH GLOMB REALTY TO COVER THE COST OF PROCESSING THE APPLICATION AS FURNISHED BY THE APPLICANT(S).

APPLICATION DEPOSIT AGREEMENT: APPLICANT HAS DEPOSITED AN APPLICATION DEPOSIT IN THE AMOUNT STATED BELOW IN CONSIDERATION FOR OWNER TAKING THE DWELLING UNIT OFF THE MARKET WHILE CONSIDERING APPROVAL OF THIS APPLICATION. IF APPLICANT IS APPROVED AND CONTEMPLATED RENTAL AGREEMENT IS ENTERED INTO, THE APPLICATION DEPOSIT SHALL BE CREDIT TO THE FIRST MONTHS RENT. IF APPLICANT IS APPROVED BUT FAILS TO PROMPTLY ENTER INTO THE CONTEMPLATED LEASE AGREEMENT, THE APPLICATION DEPOSIT SHALL BE FORFEITED TO OWNER. THE APPLICATION DEPOSIT WILL BE REFUNDED ONLY IF APPLICANT IS NOT APPROVED. KEYS WILL BE FURNISHED ONLY AFTER THE RENTAL  AGREEMENT AND OTHER RENTAL DOCUMENTS HAVE BEEN PROPERLY EXECUTED BY ALL PARTIES AND AFTER APPLICABLE RENT AND SECURITY DEPOSITS HAVE BEEN PAID. APPLICANT(S) HEREBY DEPOSITS THE SUM OF $___________ WITH MANAGEMENT AS A GOOD FAITH AND/OR HOLDING DEPOSIT IN CONNECTION WITH THIS RENTAL APPLICATION AN IF MY APPLICATION IS APPROVED AND I FAIL TO ENTER INTO A RENTAL AGREEMENT OR FAIL TO TAKE POSSESSION UNDER THE TERMS OF MY RENTAL AGREEMENT IF ONE HAS BEEN SIGNED, I UNDERSTAND AND AGREE THAT THE ENTIRE GOOD FAITH DEPOSIT SHALL BE FORFEITED BY ME. IN ADDITION, IF I HAVE ALREADY ENTERED INTO A RENTAL AGREEMENT, I WILL BE HELD LIABLE FOR ALL RENTS AND DAMAGES AS SET FORTH IN THE RENTAL AGREEMENT. IF MY APPLICATION IS NOT APPROVED, I WILL RECEIVED A REFUND OF MY GOOD FAITH DEPOSIT DEPOSIT IN FULL WITHIN 30 DAYS. IF MY APPLICATION IS APPROVED, A RENTAL AGREEMENT IS SIGNED, AND, I TAKE POSSESSION OF THE CONDO/HOME, THE GOOD FAITH DEPOSIT SHALL BE APPLIED TOWARDS MY SECURITY/DAMAGES DEPOSIT.

APPLICANT(S) UNDERSTANDS THAT THE INITIAL MOVE IN CHARGES AND DEPOSITS MUST BE PAID IN CASHIER´S CHECK OR MONEY ORDER. APPLICANT(S) HEREBY DEPOSIT(S) $____________ON__________________, 20_____ WITH DEBORAH GLOMB REALTY. AS A NON-REFUNDABLE DEPOSIT TO BE APPLIED TO THE TOTAL MOVE-IN FUNDS REQUIRED BEFORE OCCUPANCY.

CERTIFICATION OF CORRECT INFORMATION. APPLICANT(S) CERTIFIES THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IN THIS APPLICATION IS TRUE AND CORRECT. APPLICANT(S) ACKNOWLEDGES THAT FALSE INFORMATION HEREIN MAY CONSTITUTE GROUNDS FOR REJECTION OF THIS APPLICATION. TERMINATION OF THE RIGHT OF OCCUPANCY, AND I MAY BE SUBJECT TO EVICTION, AND/OR FORFEITURE OF DEPOSITS AND MAY CONSTITUTE A CRIMINAL OFFENSE UNDER THE LAWS OF THE STATE OF FLORIDA.

IF A RENTAL AGREEMENT IS ENTERED INTO AND THE LANDLORD OR ITS AGENTS SUBSEQUENTLY LEARNS THAT INCORRECT INFORMATION WAS GIVEN PERTINENT INFORMATION WAS OMITTED, THE LEASE MAY BE TERMINATED AT LANDLORD/AGENT´S OPTION. ___________(INITIALS) _______________(INITIALS)

DEBORAH GLOMB REALTY DOES BUSINESS IN ACCORDANCE WITH THE FEDERAL FAIR HOUSING LAW, AND DOES NOT DISCRIMINATE AGAINST ANY PERSON BECAUSE OF RACE, COLOR, RELIGION, SEX, HANDICAP, FAMILIAL STATUS OR NATIONAL ORIGIN.   APPLICANT(S) ACKNOWLEDGE THAT DEBORAH GLOMB REALTY IS THE AGENT FOR THE PROPERTY OWNER. ___________(INITIALS) _________(INITIALS)

DATE                                              APPLICANT SIGNATURE

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DATE                                            APPLICANT SIGNATURE

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