VP Application

R E S I D E N T I A L R E N TA L A P P L I C AT I O N
Landlord:
Address of Rental Property:
Desired date of occuoancv: Desired length of occuDanov:
A P P L I C A N T I N F O R M AT I O N
Name: Erin Smith/Saffy Date of Birth 05/03/1980
Social Security No.: 194 68 6339 Driver's License No: F000-104-013-300
RENTAL HISTORY
Present Address 941 Wescott Trail #103 Eagan MN 55123
How long at present address 2yrs H o m e P h o n e N o . : 651-409-1223
Current rent payment: $1500/mth Reason for moving Moving to PA after divorce
L a n d l o r d ' s N a m e : Reece Bandy P h o n e N o . : 336-320-8072
Prior Address 4335 Pheasant Ridge Dr

How long at prior address 6mths Ex-Husband's Family, don't have number
Current rent payment: $500/mth Reason for movinc Found an apartment
Landlord's Name: Family - ex's Aunt Alicia Phone No.: ( '
SPOUSE INFORMATION (if a; ) l i c a b l e l

Name of Spouse: N/A Date of Birth
Social Security No.: Driver's License No:
NAMES OF OTHER TENANTS, INCLUDING CHILDREN AND ANYONE WHO WILL LIVE WITH
YOU (EVEN ON A TEMPORARY BASIS)
No. of occupants: Adults: Children: 1
N a m eRhys Rout Adult: □ C h i l dx' s A g e : 19
Present A Same
d d r e as
s sErinH o m e Phone No.: ( )
H o w l o n g a t p r e s e n t aall
d dinfo s : R e l a t i o n s h i p : son
r e ssame
O c c u p a UPS
t i o nWarehouse
: S c h o o l : Eagan High School
Name Adult: □ Child's Age:
Present Address Home Phone No.: ( )
How long at present address: Relationship:
Occupation: School:
Name Adult: □ Child's Age:
Present Address Home Phone No.: ( )
How long at present address: Relationship:
Occupation: School:
IF A SECOND ADULT WILL BE RENTING THE PREMISES. THEY WILL NEED TO COMPLETE A
S E PA R AT E R E N TA L A P P L I C AT I O N F O R M .
VEHICLES
Ve h i c l e M o d e l : No Car Ye a r : Ve h i c l e M o d e l : Ye a r :
License No.: License No.:
PETS □ Ye s □x No
Name Name
Type/Breed: Ty p e / B r e e d :
Size: Size:
MISCELLANEOUS
Water bed: □ Ye s □x No Smokers: □ Ye s □x No
Do you own real estate? □ Yes x□ No

If yes, please explain where:
Have you ever been evicted from any rental premises? □ Yes x□ No
If yes, please explain:
Have you ever willfully and intentionally refused to pay rent when due? □ Yesx □ No
Have you ever been convicted of a felony? □ Yes □x No

CURRENT EMPLOYER:
E m p l o yConcentrix
er: Business P h o n e : 800-747-0583
P o s i t i oSME/SUP
n on AMEX
H oProject
w Ion Since March of 2023
S u p e r v i sSarah
or Weise Annual Income 31200 Gross before bonuses
Other Income sources: Gov't assistance $ Child support/Alimony$ Other $
SPOUSE'S CURRENT EMPLOYER:

Employer: Business Phone:
Position How Ion
Supervisor Annual Income
Other Income sources: Gov't assistance $ Child support/Alimony$ Other $
NEAREST RELATIVE NOT LIVING WITH YOU:

Name Briar Swanson
Address Somerset, PA
R e l a t i o n s h i i Daughter Home Phone No. 267-463-8307
CREDIT/PERSONAL REFERENCES:
Name: Kareen Stahle Name: Ricardo Almaraz
A d d r e s s : Dover, PA A d d r e s s : Mt. Airy, NC
Phone No.: 717-507-8866 Phone No.: 336-467-4363
Relationshi Friend of 16 years Relationshi friend known for 3 years
BANK REFERENCES:
Name: SoFi Bank Name:
Online Bank
xxxxxxxxxx3408
CREDIT CARDS:
Credit Card Name: None Credit Card Name
Account No.: Account No.:
Expiration date: Year Issued: Expiration date: Year Issued:
Credit limit: Balance owed: Credit limit:
Monthly payment:
Credit Card Name: Credit Card Name
Account No.: Account No.:
Expiration date: Year Issued: Expiration date: Year Issued:
Credit limit: Balance owed: Credit limit: Balance owed:
Monthly payment: Monthly payment:
Landlord does not discriminate against any applicant on the basis of an ilegal purpose
including, race, color, religion, sex, national origin, age, disability or family status Such
discnmination as the sole basis of re^sal to rent is ilegal throughout the United States.
Local or State laws may provide additional protected classes from discrimination. You
can call the U.S. Department of Housing and Urban Development (HUD) at 1-800-424-
8590 to ask questions about discrimination.
I represent that the Information provided in this Application Is true and correct to the best
of my knowledge.
I understand that this Application is not a rental agreement and that this Application
does not create any obligation on the Landlord.
I understand that the information provided might be used by Landlord to determine

whether to accept this Application. I authorize Landlord to verify ail the information given
in this application. Including banking and personal references and employment
information provided.
I also authorize Landlord to perform a credit check and a criminal history check. I
consent to the release of Information relating to my credit and the information
provided in this application.
11/21/2024
Spouse/Co-Applicanfs Signature

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R E S I D E N T I A L R E N TA L A P P L I C AT I O N

Prior Address 4335 Pheasant Ridge Dr

SPOUSE INFORMATION (if a; ) l i c a b l e l

Do you own real estate? □ Yes x□ No

Have you ever been convicted of a felony? □ Yes □x No

SPOUSE'S CURRENT EMPLOYER:

NEAREST RELATIVE NOT LIVING WITH YOU:

I understand that the information provided might be used by Landlord to determine

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