Rental Application & Credit Report Authorization

View Application Process
Download PDF Application

Property Location

Personal Information

First Name	*
Last Name	*
Date of Birth	*
Marital Status	*
Phone	*
E-Mail	*
SSN	*

Other Occupants

First Name	Last Name	Email	Date of Birth	SSN

Current Residence

Address	*
City	*
State	*
Zip	*
Move in Date	*
Current Landlord	*
Landlord Phone	*
Current Rent	*
Reason For Leaving	*

Previous Residence

Previous Address
Previous City
Previous State
Previous Zip
Move In Date
Move Out Date
Previous Landlord
Landlord Phone
Previous Rent
Reason For Leaving

Employment Information

Current Status	*
Current Employer	*
Hire Date	*
Employer Address	*
Employer Phone	*
Position	*
Supervisor	*
Current Income	*
Frequency of income	*
Other Income

Nearest relative not living with you

Full Name
Phone
Address
City
State
Zip

Character Reference

Full Name
Phone
Address
City
State
Zip

Credit Reference

Bank/Credit Union	*
Branch	*

Pets

Do You Have Pets?	*
If yes, list breed and weight of each

Additional Information

Have you ever been convicted of a felony? (If yes, explain)	*
Have you ever been evicted? (If yes, explain)	*
Do you have a criminal background? (If yes, explain)	*

Emergency Contact Information

Contact Name	*
Relationship	*
Address	*
Phone	*

Please Read Carefully Before Submitting

I am applying to lease the above-described premises for the term specified and the conditions as set forth in an N.C.R.L.lease. I agree to pay with this application a non-refundable application fee of $45.00 to cover credit report, rental reference, employment and income verification. I agree to pay the entire security deposit with certified funds within 24 hours after acceptance. If I do not pay the security deposit within 24 hours, the property will no longer be held for me. I understand that I have 72 hours to change my mind with no penalty. After this period has expired, I will receive my security deposit back minus a $250.00 holding fee. I AUTHORIZE INTRACOASTAL REALTY TO ORDER MY CREDIT REPORT FROM EQUIFAX CREDIT CHECK FOR THE PURPOSE: OF REAL ESTATE RENTAL.

	*
	Please enter the characters in the image