Property Address *

Move In Date *

First Name *

Last Name *

Birthdate (1/11/1970) *

SSN *

Driver's License No. *

Vehicle Make *

Vehicle Model *

Vehicle Year *

Vehicle Plate No. *

Phone Number *

Cell Number

Work Number *

Email Address *

Street Address *

City *

State *

Zip Code *

Rent / Own * Rent Own

Monthly Rent * $

Landlords Name *

Landlords Phone *

Have you ever been evicted? * Yes No

Street Address *

City *

State *

Zip Code *

Rent / Own * Rent Own

Monthly Rent * $

Landlords Name *

Landlords Phone *

Employer *

Street Address *

City *

State *

Zip Code *

Contact Name *

Contact Phone *

Salary $

How Long

Bank *

Branch *

Account No. *

Have you ever filed Bankruptcy? * Yes No

Name *

Phone *

Name *

Phone *

* Required information only if there are other occupants.

Name

Birthdate (1/1/1970)

Name

Birthdate (1/1/1970)

Name

Birthdate (1/1/1970)

Applicant(s) certify that the information is true and correct and authorize landlord/agent to make any inquiries deemed necessary to evaluate the application for tenancy and credit standing. Applicant understands and accepts that any information provided that is incomplete, inaccurate, or falsified shall be grounds for denial of the application or subsequent termination of tenancy upon determination of such information. It is understood that the premises will be rented to the number of adults and children stated in this application; and that no other tenants or pets other than those specified, will occupy the premises. This application is subject to approval by the owner or his/her agent. I understand the Oregon Law requires 30 days advance notice in writing of my intention to vacate, otherwise I am liable for rent for 30 days from the time I give such notice in writing.

I have read the terms of this appplication and agreee to them. *