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APPLICATION FOR OCCUPANCY Re/Max Achievers 14175 W Indian School Rd #B-10 Goodyear, AZ 85338 Office 623-877-4700 Fax 623-535-0200 How did you hear about us? ___________________________ Best Phone # To Reach You____________________________ PROPERTY ADDRESS__________ _________________________________________________________________________________________________________ DESIRED DATE OF OCCUPANCY_________________________________________________________________________________________________________ NAME__________________________________________________ _( ) Married ( )Divorced (how long)_______________ ( )Separated ( )Single DATE OF BIRTH_________________________________________SOCIAL SECURITY NUMBER ____________________________________________________ SPOUSE’S NAME________________________________________ MAIDEN NAME IF MARRIED LESS THAN 2 YEARS__________________________________ DATE OF BIRTH_________________________________________SOCIAL SECURITY NUMBER______________________________________________________ RESIDENCE HISTORY PRESENT RENT/MORTGAGE PAYMENT $__________________________ PRESENT _________________________________________________CITY/STATE/ZIP CODE______________________________PHONE______________________ LANDLORD_____________________________________________________________________PHONE_______________________HOW LONG?_________________ (name, address, city & state-show mortgage company & account # if owned) PREVIOUS _________________________________________________CITY/STATE/ZIP CODE_____________________________PHONE______________________ LANDLORD____________________________________________________________________PHONE________________________HOW LONG?_________________ EMPLOYMENT & BANK REFERENCES A. EMPLOYED BY__________________________________________________________________PHONE______________________HOW LONG?_______________ ADDRESS_______________________________________________________________________CITY________________________ZIP CODE__________________ If less than six months, DEPT. OR POSITION_________________________________________________APPROX. MONTHLY GROSS INCOME________________ please fill in below Previous Employer ___________________________________________________________________PHONE____________________ _DATE LEFT___________________ B. SPOUSE’S EMPLOYER___________________________________________________________PHONE_______________________HOW LONG?_______________ ADDRESS___________________________________________________________________ CITY___________________________ZIP CODE__________________ If less than six months, DEPT. OR POSITION_________________________________________________APPROX. MONTHLY GROSS INCOME________________ please fill in below Previous Employer ______________________________________________________________________PHONE___________________ _DATE LEFT_________________ C. BANK REFERENCE___________________________________________________________BRANCH__________________ _PHONE_______________________ ACCT.# (savings)__________________________________________________________ACCT.#(checking)________________________________________________ D.OTHER INCOME_________________________________________________________________________________________________________________________ (indicate source & amount) CHARACTER REFERENCES
In case of emergency notify:___________________________________________________________________________________________________________________ Nearest living relative________________________________________________________________________________________________________________________ (name, address, city state & phone #) Character Referenceses: 1._____________________________________________________address___________________________________________________phone_________________ 2._____________________________________________________address___________________________________________________phone_________________ additional information Number of People Who will occupy: __________________ List them and social number of each person over 18 years of age. ______________________________________________________________________ ________-_________-__________ ______________________________________________________________________ ________-_________-__________ ______________________________________________________________________ ________-_________-__________ ______________________________________________________________________ ________-_________-__________ Description of pets:_______________________________________________________________________________________ (AGE, WIEGHT, BREED, GENDER, ETC.) Number of Vehicle (inc. company. cars):_____________________________________ This application must be signed by applicant before consideration by Landlord. Acceptance of application and applicant, and any monies deposited herewith, is not binding upon Landlord until approved by Landlord. Upon acceptance of application all deposited monies, except the non-refundable application fee, will be held as a reservation deposit to be applied to any deposit required of applicant at the time a rental agreement is executed. If applicant should withdraw AFTER ACCEPTANCE, a minimum of $_____________ WILL BE RETAINED by the landlord in addition to the non-refundable application fee. IF AFTER 7 DAYS applicant Withdraws or fails to exercise rental agreement, ALL DEPOSIT MONIES WILL BE FORFEITED. If Landlord or agent rejects the application all monies will be refunded, except the non-refundable application fee. UNDER NO CONDITION WILL APPLICATION FEE BE REFUNDED. Earnest Deposit with application $_________________________ Application fee (NON-REFUNDABLE, CERTIFIED FUNDS ONLY) $40.00**______ (Per Person) **$40.00 application fee per person applies to U.S. residents only. Additional fees will apply for non U.S. residents, and will vary according to current rates. IF YOU ARE A NON-US RESIDENT, PLEASE CALL FOR CORRECT APPLICATION FEE AMOUNT BEFORE APPLYING. Total Deposit with application $_________________________ I hereby authorize RE/MAX Achievers, to investigate the information supplied by me and to conduct inquiries concerning my income, credit and character for the purpose of verifying and qualifying for this rental. A full disclosure of pertinent facts may be made to Landlord and/or any cooperating broker/agent that may be involved. FALSIFYING INFORMATION ON THIS APLLICATION IS GROUNDS FOR REJECTION. _______________________________ _______________________________ Signature Date Signature Date FOR OFFICE USE ONLY DUAL? YES Ÿ NO Ÿ CO-BROKE? YES Ÿ NO Ÿ EXCLUSIVE? YES Ÿ NO Ÿ REFERRED BY______________________________________ AT_________________________________________ ACCEPTED / REJECTED IF REJECTED, DATE DENIAL LETTER SENT___________________________
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