To be completed by each ADULT APPLICANT

Applicant Information

Current Residence

Previous Residence

Employment / Income

Current Employer
Previous Employer
Additional Sources of Monthly Income
(List all income to be included for qualification)

Emergency Contact

Additional Information

Vehicle 1
Vehicle 2
Pets

Will You Be Moving In Any Of The Following Items?




Approximate number of units currently available, or which will in the forseable future be available, of the size and in the area requested by applicant: unit(s). Approximate number of applications previously accepted and currently under consideration for those units: application(s). If the blanks above are not filled in, then there is at least one unit available and there are no applications ahead of yours currently under consideration.

I certify that the above information is correct and complete and hereby authorize you to do a credit check and make any inquiries you feel necessary to evaluate my tenancy and credit standing. I understand that giving incomplete or false information is grounds for rejection of this application. If any information supplied on this application is later found to be false, this is grounds for termination of tenancy. Owner/Agent has charged a screening charge as set forth above. Applicant screening entails the checking of the applicant’s credit, rental history, employment history, public records and other criteria for residency. The applicant has the right to dispute the accuracy of any information provided to the owner/agent by the screening service or credit reporting agency. Applicant’s copy of this signed application and / or email verification shall be the receipt for the screening charge. The screening service is Pacific Screening Inc., P.O. Box 25582, Portland, OR 97298 (503) 297-1941. If the applicant is approved, applicants will have _________ hours from the time of notification to either execute a rental agreement and make all deposits required thereunder or make a deposit to execute a rental agreement which will provide for the forfeiture of the deposit if applicants fail to execute the rental agreement. If applicants fail to timely take the steps required above, they will be deemed to have refused the unit and the next application for the unit will be processed. Owner / Agent shall have no liability to applicant until such time as a rental agreement is signed by both parties. Applicant acknowledges receipt of a copy of the Criteria for Residency. The information contained in this application is true and complete.