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RENTAL APPLICATION Mail, fax or email application to the Landlord:
Shelby H. Edwards 315 Gold St. Juneau, AK 99801 Phone: (907) 586-1964 Fax: (907) 586-9863 email: rentals@goldstreetinn.com
This Application is made to rent: Cashen Quarters 303 Gold St. Juneau, AK 99801 For a term of 4 months or 8 months. Desired date of occupancy: _______________________________________ Desired length of occupancy: ______________________________________ No. Of Bedrooms:____________ Reason for moving:_____________________________________________
The following deposits are required *$50 for each additional person - Security/cleaning deposit of $ 500.00
APPLICANT INFORMATION
Name: ____________________________________________________________ Age:____
No. Of occupants: Adults: _____ Children: _____ Smokers: Yes _____ No _____ Pets: Yes _____ No _____
PRESENT ADDRESS: ________________________________________________ How long at present address: __________________________ Home Phone No.: (____)_______________ Landlord's Name: ___________________________________________________ Phone No.: (____)____________ Current rent payment: ____________
PRIOR ADDRESS: ____________________________________________________ How long at prior address: ____________________________ Landlord's Name: ____________________________________________________ Phone No.: (____)______________________ Rent payment: ____________ Reason for moving: ___________________________________________________
Social Security No.: _______-______-_______ Driver's License No. :__________________ Vehicle Model: _____________________Year: __________ License No.: __________________
SOURCES OF INCOME: Wages $__________ Salary $__________ Commission $__________ Tips $__________ Gov't assistance $__________ Child support/Alimony $__________ Other $__________
CURRENT EMPLOYER: Employer: _____________________________________________________ Position: ____________________ How long: __________________ Supervisor: __________________ Business Phone: (____)________ Annual Income: _________________________________________________
PRIOR EMPLOYER: Employer: _____________________________________________________ Position: ____________________ How long: __________________ Supervisor: __________________ Business Phone: (____)________ Annual Income: _________________________________________________
NEAREST RELATIVE NOT LIVING WITH YOU: Name: ___________________________________________________________ Address: __________________________________________________________ Home Phone No.: (____)____________ Relationship: _____________________
PERSONAL REFERENCES (no friends or relatives): Name: __________________________________________________________ Address: _________________________________________________________ Phone No.: (____)________________ Relationship: ____________________ Name: ___________________________________________________________ Address: _________________________________________________________ Address: __________________________________________________________ Phone No.: (____)________________ Relationship: ____________________ Do you own real estate? Yes ____ No ____ if yes, please explain where: __________________________________________________________________ __________________________________________________________________
Have you ever been evicted from any rental premises? Yes ____ No ____ If yes, please explain: ___________________________________________________________________ ___________________________________________________________________
Have you ever willfully and intentionally refused to pay rent when due? Yes ____ No ____ If yes, please explain: ___________________________________________________________________ ___________________________________________________________________
Are there any circumstances that may interrupt your income or ability to pay rent? Yes ____ No ____ If yes, please explain: ___________________________________________________________________ ___________________________________________________________________
Have you ever been convicted of a felony? Yes ____ No ____ If yes, please explain: ____________________________________________________________________ ____________________________________________________________________
I represent that the information provided in this Application is true and correct to the best of my knowledge. Shelby H. Edwards is authorized to verify the references and employment information given in this Application. _____________________________________________ _______________ Applicant's Signature Date
IF A SECOND ADULT WILL BE RENTING THE PREMISES, THEY WILL NEED TO COMPLETE A SEPARATE RENTAL APPLICATION FORM. |