RENTAL APPLICATION

ADDRESS OF RENTAL PROPERTY: _____________________________________________________________________

PLEASE NOTE: A separate application is required for each applicant over the age of 18 (excluding dependent children) who will
reside at the property. This is to guarantee compliance with the state and Federal Fair Housing Acts.

THE FOLLOWING TWO OPTIONS* ARE MADE AVAILABLE TO ALL APPLICANTS:

FIRST OPTION: Applicants desiring to live together as a single housekeeping unit may elect to financially qualify for tenancy as a group, in which
case Landlord has the right to immediately terminate the rental contract when any one member of that group vacates the property.
SECOND OPTION: Each legal entity may elect to financially qualify for tenancy individually, in which case the occupant may continue to lease the
property if one or more of the other parties to the rental contract vacate the property for any reason.
*PLEASE NOTE: All applicants desiring to live together must choose the same option
I elect the first option. I elect the second option. Desired Length of Occupancy: ______________ Desired Move-In Date: ______________

APPLICANTS WILL NOT BE ACCEPTED ON "A FIRST-COME, FIRST-SERVED BASIS." LANDLORD WILL ASSIST ALL PERSONS WITHOUT REGARD TO RACE,
COLOR, CREED, SEX, RELIGION, NATIONAL ORIGIN, FAMILIAL STATUS, MARITAL STATUS, HANDICAP, OR ANCESTRY.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
PLEASE PRINT LEGIBLY OR TYPE

Applicant's Name _____________________________________________________ Driver's Lic # ______________________ Soc Sec # ________________________

Home telephone # _____________________________ Work Telephone #_______________________________ Mobile Telephone # __________________________

LIST YOUR LAST FOUR YEARS RESIDENCE HISTORY & AT LEAST YOUR LAST TWO ADDRESSES

Current Address ________________________________________________________ City____________________________ State____________ Zip____________

Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.) ______________________________________________________________
How long at present address?_________________________________ Occupancy dates______________ Why moving _______________________________________
Landlord's name ______________________________________________________________________________ Phone #____________________________________
Current monthly rent or mortgage payment?______________________________________________ If you own your current residence, please supply name and address
of Mortgage Co__________________________________________________________________________________________________________________________
Loan# ________________________________________________________________________________Phone#___________________________________________

Former address _________________________________________________________City____________________________ State____________ Zip_____________

Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.)______________________________________________________________
How long at former address? _________________________________ Occupancy dates ______________ Why moved_ ______________________________________
Former Landlord's Name _________________________________________________________________ Phone # __________________________________________

Former address _________________________________________________________City____________________________ State ____________ Zip ____________

Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.)______________________________________________________________
How long at former address?____________________________________ Occupancy dates ____________ Why moved ___________________________________ ___
Former Landlord's name __________________________________________________________________ Phone # _________________________________________

Former address _________________________________________________________City____________________________ State ____________ Zip ____________

Type of property? (apartment, duplex/4-plex, townhouse, condo, mobile home, house, etc.)______________________________________________________________
How long at former address?____________________________________ Occupancy dates ____________ Why moved ___________________________________ ___
Former Landlord's name __________________________________________________________________ Phone # _________________________________________

LIST YOUR EMPLOYMENT HISTORY FOR THE LAST FOUR YEARS

(List military rank if applicable)

Current Employer ___________________________________________________________________ Dates: _________________________ Phone # __________ ___

Address _______________________________________________________________ City ____________________________ State ___________ Zip _____________
Position / Job description __________________________________________________________________________________Monthly gross pay $________________
Mo take-home________ Superior's name & position ________________________________________________________________________Phone # ______________
List any additional monthly income (child support, SS, etc.)_______________________________________________________________________________________

Former Employer ___________________________________________________________________ Dates: _________________________ Phone # __________ ___

Address _______________________________________________________________ City ____________________________ State ___________ Zip _____________
Position / Job description __________________________________________________________________________________Monthly gross pay $________________
Mo take-home________ Superior's name & position ________________________________________________________________________Phone # ______________

Former Employer ___________________________________________________________________ Dates: _________________________ Phone # __________ ___

Address _______________________________________________________________ City ____________________________ State ___________ Zip _____________
Position / Job description __________________________________________________________________________________Monthly gross pay $________________
Mo take-home________ Superior's name & position ________________________________________________________________________Phone # ______________

Mail to: Scott Britton, Agent, P.O. Box 16204, Jackson, MS 39236-6204
APPLICATIONS WILL NOT BE PROCESSED WITHOUT THE $20.00 APPLICATION FEE!
 LIST NEAREST RELATIVES
Name Address Phone Relationship
1. _____________________________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________________________

LIST ALL VEHICLES OWNED

Vehicle Make/Model/Year License No./State
1. _____________________________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________________________
3. _____________________________________________________________________________________________________________________________________

LIST ALL PETS WHICH YOUR DESIRE TO HAVE LIVE ON THE PREMISES
Pet’s Name Type/Breed/Size Sex/Neutered/Spayed Indoor/Outdoor
1. _____________________________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________________________

LIST ALL BANK ACCOUNTS

Bank Name Account# Checking/Savings Balance
1. _____________________________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________________________

CREDIT REFERENCES – LOANS & CREDIT CARDS

Name Account# Purpose $ Limit Balance Mo Payment
1. _____________________________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________________________
3. _____________________________________________________________________________________________________________________________________
4. _____________________________________________________________________________________________________________________________________
5. _____________________________________________________________________________________________________________________________________
6. _____________________________________________________________________________________________________________________________________

LIST TWO UNRELATED PERSONAL REFERENCES

Name Address City/State/Zip Phone #
1. _____________________________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________________________

PERSONAL SKILLS: ( ) Plumbing ( ) Carpentry ( ) Painting ( ) Electrical ( ) Mechanical

Other_______________________________________________________________________________________________________
TOOLS YOUR OWN: ( ) Tool Box ( ) Mower ( ) Yard tools ( ) Ladder ( ) Hoses/Sprinklers

1. Have you ever been evicted from any tenancy? ( ) Yes ( ) No

2. Have you ever willfully and intentionally refused to pay rent when due? ( ) Yes ( ) No
3. Do you know of any thing which could interrupt your income or ability to pay rent? ( ) Yes ( ) No
4. Rent is due in advance on the last business day of each month. Are you able to fulfill this requirement? ( ) Yes ( ) No
5. Have you ever filed a petition of bankruptcy? If yes, when & where? ____________________________ ( ) Yes ( ) No
6. Have you or anyone in your household ever been convicted of a felony or misdemeanor? If yes, explain ( ) Yes ( ) No
7. Would you be interested in purchasing this home, or other homes we might have available from time to time? ( ) Yes ( ) No
8. Are you obligated to pay child support or alimony? (If yes, how much? $_______________ per month) ( ) Yes ( ) No
9. Who will be living in the property with you? Name(s)/Age(s): ___________________________________________________________________________________
_______________________________________________________________________________________________________________________________________

ANY ADDITIONAL INFORMATION YOU THINK WILL HELP US PROCESS YOUR APPLICATION (attach additional information if necessary)
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Applicant agrees that if for any reason applicant becomes delinquent in rents, or other charges, Landlord is hereby authorized to use applicant's Master Charge or Visa
Account and said authorization is hereby given. Applicant also agrees that all credit information maintained by Landlord may be given to any credit reporting service or
other persons who request it. Applicant hereby certifies that the information given in this application is true and correct. Applicant understands that any false answers or
statements made will be sufficient grounds for termination and eviction.

Applicant hereby authorizes Landlord to obtain a credit report. APPLICANT AGREES TO PAY THE REQUIRED FEE OF $20.00 FOR EACH INDIVIDUAL
CREDIT REPORT. APPLICANT UNDERSTANDS AND AGREES THAT APPLICANT WILL NOT RECEIVE A COPY OF THIS CREDIT REPORT.

Applicant authorizes present and past Landlords and Employers, Banks, Credit References, Personal References, and any other person to release information
regarding applicant's credit, rental, employment and/or criminal histories. A copy of this authorization may be accepted as an original.

Date ____________________ ___________________________________________

Applicant's Signature
___________________________________________
Date of Birth (needed to pull credit report)

Mail to: Scott Britton, Agent, P.O. Box 16204, Jackson, MS 39236-6204
APPLICATIONS WILL NOT BE PROCESSED WITHOUT THE $20.00 APPLICATION FEE!