Residential Application - EIP - Eastern Illinois Properties

First Name

Last Name

Cell Phone

Email Address

Date of Birth

Social Security Number

Driver's License Number

Pets?

No Pets

Dog

Cat

Other

Current Employer

Position

Start Date

Compensation (Per Month)

Current Landlord Name

Landlord Phone Number

Reason For Leaving

Rent Amount

Move In Date

Move Out Date

Has Notice Been Given?

Current Street Address

Current City

Current Zip Code

Current State

Vehicle Make

Vehicle Model

Vehicle Year

License Plate Number

General Information (Select any that applies)

I smoke or someone living in the rental unit smokes.

I have filed for bankruptcy (currently or previously).

I have been convicted for selling, possessing, distributing, or manufacturing, illegal drugs or convicted, of any other major crimes (felonies).

I have been evicted for non-payment of rent or due to other reasons.

None of these apply.

Disclosure #1

By checking this box applicant(s) hereby consent to allow the owner, manager, or his/her/their agent (hereinafter "Landlord") to obtain credit information, criminal history and related information regarding the applicant(s) for the purpose of determining whether or not to enter into a lease with the applicant(s). Applicant(s) understand that Landlord shall have a continuing right to review applicant's credit information, rental application, payment history, occupancy history, criminal background history and related information for account review purposes and for improving application methods.

Disclosure #2

By checking this box applicant(s) hereby declares that all information provided on this Rental Application is complete, true, and correct to the best of his/her/their knowledge. Applicant(s) hereby authorizes the owner, manager, or his/her/their agent (hereinafter "Landlord") to verify any information at any time contained in this application, including but not limited to, verification of current residency and employment. This application is for preliminary screening use only and does not obligate Landlord to execute a rental agreement or deliver possession of the premises. Applicant(s) further acknowledges that any false or fraudulent information contained herein will void this application and terminate any rental agreement.