LOOKING FOR A RENTAL?

First Name:: *
Last Name:: *
Email:: *
Phone or Cell: *
Present Address: *
How long at this address?: *	Select One... Less Than 3 Months Less Than 6 Months More Than a Year OTHER
Name of Landlord: *
Landlords Phone #: *
REASON FOR LEAVING?: *
PREVIOUS ADDRESS: *
How Long at Previous Address: *	Select One... LESS Than 3 Months LESS Than 6 Months One Year or More OTHER
Previous Landlords Name: *
Previous Landlord Ph #: *
REASON FOR LEAVING: *
PROPOSED OCCUPANTS: *	Select One... One Occupant Two Occupants Three Occupants Four Occupants More Than 4 Occupants
Do You Have Pets?: *	Select One... YES NO 1 Small Dog 1 Large Dog 1 Cat One Cat & 1 Dog OTHER
Inside or Outside Pets: *	Select One... NO Pets INside Pets OUTside Pets BOTH Other
Liquid Filled Furniture?: *	Select One... Yes No Maybe in future OTHER
PRESENT Occupation: *
PRESENT Employer: *
Length of Time On Job: *
Employer/Supervisor Name & PH #: *
PRIOR OCCUPATION: *
Previous Employer: *
Length of Time on Job: *
Previous Employer Name & Ph#: *
CURRENT MONTHLY INCOME: *
OTHERS EMPLOYED living in House/apt: *
What is their INCOME:
LIST 3 PERSONAL REFERENCES, Their Ph# & Occupation: *
Ideal length of Lease: *	Select One... Minimum of 30 days Less Than 6 months Minimum of 1 year Minimum of 2 years
LIST Year & Make of Automobile(s): *
Have You ever filed for Bankruptcy?: *	Select One... YES NO
Have You Ever Been Evicted?: *	Select One... YES NO
Have You ever been Late on RENT?: *	Select One... YES NO Once More Than Twice More than 4 times
What are you paying for RENT now?: *
What are You paying for UTILITIES?: *
How Much Are You Capable of Paying For RENT?: *
Applicant would like to obtain RENTAL within?: *	Select One... 30 Days 60 Days Next 3-4 Months Immediately
Any special needs or comments you want to share (i.e., I only want a house, no apartment,..):
Applicant hereby authorizes any Landlord to check out the above information.: *	Select One... YES NO
Applicant hereby releases any landlord from any liability related to information contained in this application for rent/ or in verification of any information in this application: *	Select One... YES NO
Applicant hereby states, To the best of my knowledge these statements herein are true.: *	Select One... YES NO
List Your Initials & TODAYS DATE: *
Enter Code Shown:*

Be patient, depending on time of year and the qualifying information you submit it could be days to weeks before you get a response from any one of these landlords.

IMPORTANT NOTE:  Au Glaize Real Estate has NOTHING to do with your selection. We simply forward these applications on to landlords who have volunteered to be placed in our database. They review your application and IF they are interested respond directly to you by phone or email.