Rental Application

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PERKINS REALTY LLC RENTAL APPLICATION

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APPLICANT INFORMATION

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Current Address*
Owned/Rented

PREVIOUS ADDRESS(ES) FOR THE PAST FIVE (5) YEARS

Address 1
Owned/Rented*
Address 2*
Owned/Rented
Address 3
Owned/Rented

EMPLOYMENT INFORMATION

Employer Address*
Income Type

EMERGENCY CONTACT

Employer Address

CO-APPLICANT (IF APPLICABLE)

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Current Address
Owned/Rented

CO-APPLICANT PREVIOUS ADDRESS(ES) FOR THE PAST FIVE (5) YEARS

Address 1
Owned/Rented
Address 2
Owned/Rented

CO-APPLICANT EMPLOYMENT INFORMATION

Employer Address
Income Type

LIST OTHER OCCUPANTS

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REFERENCES

BACKGROUND INFORMATION

Filed for bankruptcy*
Willfully or intentionally refused to pay rent when due*
Been evicted from a tenancy or left owing money?:*
Been convicted of a crime?*

OTHER INFORMATION

I/we, the undersigned, authorize Perkins Realty, Landlord and its agents to obtain an investigative consumer credit report including but not limited to credit history, OFAC search, landlord/tenant court record search, criminal record search and registered sex offender search. I authorize the release of information from previous or current landlords, employers, and bank representatives. This investigation is for resident screening purposes only, and is strictly confidential. This report contains information compiled from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold Perkins Realty, Landlord and its agents free and harmless of any liability for any damages arising out of any improper use of this information.

Important information about your rights under the Fair Credit reporting Act:
• You have a right to request disclosure of the nature and scope of the investigation.
• You must be told if information in your file has been used against you.
• You have a right to know what is in your file, and this disclosure may be free.
• You have the right to ask for a credit score (there may be a fee for this service).
• You have the right to dispute incomplete or inaccurate information. Consumer reporting agencies must correct inaccurate, incomplete, or unverifiable information. These reports are being processed by Perkins Realty, 8381 Millwood Drive, Springfield, VA 22152, (484) 213-7301. A summary of your rights under the Fair Credit Reporting Act is available by visiting or writing (Para information en espanol, visite o escribe): http://www.ftc.gov/credit Consume.

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Please fill out the application form