Lease Application

Company

This field is for validation purposes and should be left unchanged.

Date of Application

Name of Building

Address of Building

Street Address Address Line 2 City State

Name of Tenant

First Last

Current Home Phone #

Cell Phone #

Work Phone #

Drivers License

State

Social Security #

D.O.B.

Marital Status

Spouses Name

Childrens Names

Present Address

Street Address Address Line 2 City State ZIP Code

How Long?

Reason for Leaving

Name of Owner/Manger

Phone Number of Owner/Mangaer

Place of Employment

Address

Street Address Address Line 2 City State ZIP Code

Supervisors Name

First Last

Supervisors Phone

Your Job Title

Work Hours

Monthly Pay

How Long at Current Job?

Other Source of Income

Tenant 2

Name of Tenant #2

First Last

Current Phone #

Cell Phone #

Work Phone #

SS# Tenant 2

Drivers License #

Date of Birth

Present Address

Street Address Address Line 2 City State ZIP Code

How Long?

Reason For Leaving

Name of Owner/Manager

First Last

Phone # of Owner/Manager

Place of Employment

Address of Employment

Street Address Address Line 2 City State ZIP Code

Supervisor Name

First Last

Supervisor Phone #

Work Hours

Job Title

Work Hours

Monthly Pay

How Long at Current Job?

Other Sources of Income

Disclosure of Manager

The agent for the Landlord/Management of the premises is PALMETTO STATES PROPERTIES

Phone: 954-549-7405
Email: [email protected]
Address: 4303 NE 1st Terrace #2
Oakland Park, Florida 33334-3157

OWNER DISCLOSURE
The owner of the premises of a person authorized to act for and on behalf of the owner for the purpose of service or process and receiving and receipting for notices and demands is disclosed as:

Name: PALMETTO STATES PROPERTIES
Address: 4303 NE 1st Terrace #2
Oakland Park, Florida 33334-3157

Phone: 954-549-7405
Email: [email protected]

Radon Gas Disclosure

Radon is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines have been found in buildings in every state of the United States. Additional information regarding radon gas may be obtained from your County Public Health Unit. See also https://www.epa.gov/radon

Consent to Credit Check

Name

First Last

Landlord Name

I/we, (name above) the undersigned applicant(s) authorize landlord,(name above), or his/her/their agent to order and review my/our credit and criminal history and investigate the accuracy of the information contained in the application. I/We further authorize all banks, employers, creditors, credit card companies, references and any and all other persons to provide to the Landlord any and all information concerning my/our credit.

Date

Signature

Date

Signature

CAPTCHA

Tenant 2

Motor Vehicle Identification

Vehicle 1

Vehicle 2

Emergeny Contact

Disclosure of Manager

Radon Gas Disclosure

Consent to Credit Check