Weichert Pikes Peak

Property Information

Address Applied For *

Possession Date *

Applicant Information

Full Name

First

Middle Initial

Last

Jr/Sr

Social Security # *

Date of Birth *

Contact Information

Email *

Home Phone #:

*( )

* -

*

Cell Phone #:

( )

-

Work Phone #:

( )

-

Current Address

Street Address *

Address continued

City *

State *

Zip *

How Long *

Landlord/Mortgage Co. *

Landlord/Mortgage Co Phone #

*( )

* -

*

Payment Amount *

Reason for leaving *

Previous Address History (2 years)

Street Address

Address continued

City

State

Zip

How Long

Landlord/Mortgage Co.

Landlord/Mortgage Co Phone #

( )

-

Payment Amount

Reason for leaving

Add another address

Rental History

Have you ever been evicted? * YesNo

Have you left owing the Landlord money? * YesNo

Employment Status

Employment Info

Employed By *

Gross Monthly Income *

Employer Contact Info

Street Address *

Address continued

City *

State *

Zip *

Phone #:

*( )

* -

*

Supervisor *

How Long *

Position *

Rank/Pay Grade

Add Employer

Other Income

Income Source

Income Amount

Add Income Source

Vehicle Information

Auto Make

Model

Year

Color

Tag #

State

Add Vehicle

Emergency Contact

Who should be contacted in case of emergency *

Phone #

*( )

* -

*

Street Address *

Relationship *

Add Contact

Identification

Driver's Licence #

State

Residency

I, *

, swear or affirm under penalty of perjury under the laws of the State of Colorado that (check one):

* I am a United States citizenI am a Permanent Resident of the United StatesI am lawfully present in the United States pursuant to Federal law

I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that State law requires me to provide proof that I am Lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statue 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.

Please provide a copy of: Colorado driver's license, Colorado State I.D., Military I.D. or Tribal document.

Credit Information

Bank

Street Address

City

State

Zip

Account Type CheckingSavings

Coresident (Anyone 18 or over)

Is there a CoResident Applicant? (Anyone 18 or over) * YesNo

Residents (Anyone under 18)

Full Name

Date of birth

Relationship

Add another resident

Please list all persons who will occupy the residence.

Is anyone NOT listed on this application staying in the residence? * YesNo

Has the applicant ever been convicted of a felony or any violent, drug-related, or sexual-related misdemeanor? * YesNo

Please explain: *

Has the applicant or any household member been involved in incidents of sexual or violent activity that may adversely affect the health, safety or welfare of staff or other residents? * YesNo

Please explain: *

Pets

Do you have pets? * YesNo

Pet Info

Name *

Type *

Breed/Size *

Weight *

Color *

* MaleFemale

Add Pet

Special Requirements

You have the right to request reasonable accomodations if you have a disability or handicap. The Landlord does not discriminate on the basis of disability or handicap, and you are not required to discolse a disability or handicap.

Do you have any special requirements? * YesNo

Please explain *

Applicant Electronic Signature

We understand and consent that a credit, employment verification, criminal and rental history check of each applicant will be ordered in conjunction with this application. In the event any derogatory, inaccurate or unverifiable information is listed above or on our credit report, we understand that our application to rent may be turned down by Weichert, Realtors - Pikes Peak Group. (A $25.00 non-refundable application fee is charged to all prospective tenants to cover processing costs and credit report.) Please obtain your receipt when you turn in this application.

It is understood that the rental deposit, in the amount of $100.00 will be returned if you are not accepted as tenants or will apply towards your Security/Damage Deposit if you are accepted. If you are accepted as tenants and decide not to accept the housing applied for, the Deposit is FORFIETED. If any false information (for any reason) is given on this application, the application will be denied and the Deposit is FORFEITED. If you do not provide all of the required information within three (3) days, the Deposit is FORFEITED. If you have the option of using a cosigner to be approved, and you do not provide all of the required cosigner information, within three (3) days, the Deposit is FORFEITED. Applicant will have 72 hours from submission of application to withdraw for a refund of the $100.00. NOTICE: Applicant is advised that Weichert, Realtors - Pikes Peak Group is employed by and is an agent for the owner.

In the event more than one application is received for the same property, the more qualified applicant will be offered a lease on the property. Balance of security deposit required within 24 hours of approval.

Brokerage Disclosure To Tenant

Definitions Of Working Relationships

Customer: A customer is a party to a real estate transaction with whom the broker has no brokerage relationship because such party has not engaged or employed the broker, either as the party's agent or as the party's transaction-broker.

Relationship Between Broker and Tenant

Broker and Tenant referenced below have NOT entered into a Tenant agency agreement. The working relationship specified below is for a specific property described as:

Property Address: *

Relationship * Customer. Broker is the landlord's agent and Tenant is a customer.

Megan's Law - It the presence of a registered sex offender is a matter of concern to Tenant, Tenant understands that Tenant must contact local law enforcement officials regarding obtaining such information.

Signatures

Applicant Name *

Date: *

Add Applicant

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