PERSONAL INFORMATION   E-Mail Address * Phone Number * Name of Applicant * Date of Birth * Social Security No. * Driver's License No. * Present Address * City * State * Zip * Prior Address * City * State * Zip Time spent living at present address? Time spent living at prior address? Name of Landlord Telephone Prior Landlord Telephone How many will be living in this unit? Adults Children Pets Weight of Pets       EMPLOYMENT INFORMATION   Employer Occupation Current Salary How Long? Contact Person Telephone Name Relationship Telephone Name Relationship Telephone Name Relationship Telephone       HAVE YOU EVER   Filed for Bankruptcy Yes No If yes, when? Been Served an eviction notice or been asked to vacate a propery you were renting? Yes No   Willfully / intentionally refused to pay due rent? Yes No If yes, when? Been sued for unlawful detainer? Yes No       How were you referred to us? Newspaper Realtor Other Name of Newspaper / Realtor / Other? Commencement Date Term Rent / Month       ACKNOWLEDGEMENT   I / We the undersigned, understand that Jonas Wagner is the leasing agent and that the leasing agent's fees will be paid by the tenant. the undersigned acknowledge that this written notice was received prior to the undersigned receiving a lease agreement.   Applicants Name Date Co-Applicants Name Date     CONSENT TO OBTAIN CREDIT / EMPLOYMENT INFO   I / We authorize Jonas Wagner to investigate my / our credit qualifications and hereby release, in any manner, all of the information obtained by you. I / We further release all persons, agencies, or firms from any liabilities resulting from providing such information.       I / We declare under penalty of perjury that the information listed in this application is true and correct.   Applicant's Name Date Co-Applicants Name Date     The undersigned authorizes landlord, leasing agent, and representatives of owner / landlord to contact the undersigned's current or previous landlord, and current employer, and further, by a copy of this Application, authorizes any said landlord or employer to release pertinent residential and employment history information to be used in evaluating my lease application. I further authorize owner / landlord, leasing agent, or its representatives to apply for or obtain an investigation or credit report in connection with this application. I understand that said investigation or credit report may contain information obtained from various state governmental and private entities relative to the undersigned's number of children, employment, occupation, general health, financial, and criminal history information.