$35.00 Application Fee/Non-Refundable $37.50 through PayPal COLDWELL BANKER ROWLEY REALTORS PROPERTY MANAGEMENT 2700 KIRKWOOD HIGHWAY NEWARK, DELAWARE 19711 LAURA STAYTON PHONE (302) 995-2535 JANE PERILLO FAX (302) 995-1877 RENTAL APPLICATION PROPERTY ADDRESS:_____________________________________________ RENT AMT:_________MOVE IN:_____ PERSONAL INFORMATION APPLICANT’S FULL NAME:__________________________________________ BIRTHDATE:_______________SOCIAL SECURITY NUMBER:______-____-____ HOME #( ) - WORK # ( ) - RESIDENCE HISTORY PRESENT ADDRESS (INCL. ZIP CODE)_________________________________ LANDLORD:_______________________________PHONE #:_________________ CURRENT RENT:_____HOW LONG AT ADDRESS:____WHY LEAVING____________ PREVIOUS ADDRESS:______________________________________RENTAMT:__ LANDLORD:______________________PHONE#________________HOW LONG____ EMPLOYMENT INFORMATION CURRENT EMPLOYER & ADDRESS:______________________________________ SALARY:____SUPERVISOR___________PHONE#________HOW LONG:__________ PREV EMP:________________________________PHONE#_______HOW LONG:__ CO-RESIDENT INFORMATION APPLICANT’S FULL NAME:__________________________________________ BIRTHDATE:_______________SOCIAL SECURITY NUMBER:______-____-____ HOME #( ) - WORK # ( ) - RESIDENCE HISTORY PRESENT ADDRESS (INCL. ZIP CODE)_________________________________ LANDLORD:_______________________________PHONE #:_________________ CURRENT RENT:_____HOW LONG AT ADDRESS:____WHY LEAVING____________ PREVIOUS ADDRESS:______________________________________RENTAMT:__ LANDLORD:______________________PHONE#________________HOW LONG____ EMPLOYMENT INFORMATION CURRENT EMPLOYER & ADDRESS:______________________________________ SALARY:____SUPERVISOR___________PHONE#________HOW LONG:__________ PREV EMP:________________________________PHONE#_______HOW LONG:__ CREDIT REFERENCES BANK:________________(APPLICANT)___________________(CO-APPLICANT) CKINGACCT#’S:______________(APPLICANT)_____________(CO-APPLICANT) SAVINGSACCT:_______________(APPLICANT)_____________(CO-APPLICANT) OTHER INFORMATION LIST ALL OTHER OCCUPANTS:________________________________________ IN CASE OF EMERGENCY NOTIFY:______________________PHONE#_________ ANY PETS? ___YES ___NO (IF YES):TYPE______ AGE/SEX__/__ NAME____ AUTO INFORMATION: MAKE:__________________YEAR_________COLOR______TAG#_______STATE__ MAKE:__________________YEAR_________COLOR______TAG#_______STATE__ PLEASE INCLUDE COPIES OF PAYSTUBS AND DRIVERS' LICENSES ADDITIONAL REMARKS:______________________________________________ _________________________________________________________________ EMAIL ADDRESS:____________________________________________________ Applicant agrees that he/she is renting the premises in “as is” condition, and that he/she will comply with all State, Federal and local ordinances applicable to the demised premises and will save lessor harmless from penalties, fines, costs or damages resulting from failure to do so. Possession will be given only after execution of lease in form generally used by Agent, and payment of deposit and first full month’s rent and all other deposits have been made. It is hereby understood and agreed that Coldwell Banker Rowley Realtors is Agent only and that the owner has the right to reject this application. This broker, any cooperating broker, and any salesperson working with either, are representing the Lessor’s interest and have fiduciary responsibilities to the Lessor, but are obligated to treat all parties with honesty. The broker, any cooperating broker, and any salesperson working with either, without breaching the fiduciary responsibilities to the lessor, may, among other services, provide a potential Lessee with information about the attributes of properties, show properties, and assist in preparing an offer to rent. The broker, any cooperating broker, and any salesperson working with either, also have the duty to respond accurately and honestly to a potential Lessee’s questions and disclose material facts about properties, submit promptly all offers to lease and offer properties without unlawful discrimination. ______________________________________________________ Applicant Date ______________________________________________________ Applicant Date Fair Credit Reporting Act/Pre-Notification This is to inform you that as part of our procedure for processing your application, an investigative report may be made whereby information is obtained through personal interviews with third parties such as Credit Reporting Agencies, family members, business associates, financial sources, friends, neighbors or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, mode of living, credit history, rental history, and employment history, whichever may be applicable. You have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. www.delawarerentalhomes.com