Landlords Cell: 336-972-4932 --- email: brenda.dailey33@gmail.com
Please complete, sign, scan, and email back.
Property Applied For: 101 Hemlock Court, King, NC
Tenants Name __________________________________________ Home Phone________________________
Social Security Number _____________________________ Work Phone _______________________
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Present Address _____________________________________
How long at this address ________________________________________ Rent _________________
reason for moving _____________________________________________________________
Owner/Manager __________________________________ Phone ______________________
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Previous Address ____________________________________
How long at this address _____________________________________ Rent ____________________
Reason for moving _____________________________________________________________
Owner/Manager __________________________________ Phone ______________________
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Name and Relationship of every person to live with you: _______________________________________
_________________________________________________________________________________
Any Pets _________________ Describe _______________________________ Waterbed? ___________
Occupation ____________________ Employer ________________________Phone________________
Current gross income per month (before deductions) _______________________________________
List sources of income (other than employment listed above)_________________________________
Have you ever filed for bankruptcy? ___________________________________________________
Have you ever been evicted? _________________________________________________________
Vehicle Make(s)______________________ Model(s)_______________ Year(s) _______________
Personal Reference Name: ___________________City: ______________ Phone:_________________
Emergency Contact (Parent): _________________City: _______________Phone:_________________
I (we) declare that the forgoing information is correct and hereby authorize verification and the obtaining of
a consumer credit report.
Signature ________________________________________________ Date ____________________
Applicant Email Address (if available) ________________________________