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APPLICATION

Application

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Application Info

Each adult (18 or older) must fill out an application
There is a non-refundable fee of $25/adult to apply

Applicant

Applicant

First Name:

Middle Name:

Last Name:

Birth Date:

Social Security #:

Driver's License # / State:

Any other Names You've Gone By:

Home Phone:

Cell Phone:

Email:

Spouse

Spouse

First Name:

Middle Name:

Last Name:

Birth Date:

Social Security #:

Driver's License # / State:

Any Other Names You've Gone By:

Home Phone:

Cell Phone:

Email:

All Other Proposed Occupants: (Name / Birth Date / Relationship to Applicant)

RENTAL / RESIDENCE HISTORY

RENTAL / RESIDENCE HISTORY

Current Residence

Current Residence

Street Address:

City:

State:

Zip Code:

Last Rent Amount Paid:

Owner / Manager:

Phone Number:

Is/Was rent paid in full:

Reason for Leaving:

Did you give notice?

Were you asked to move?

Name(s) in which your utilities are now billed?

Dates of Residency:

Previous Residence

Previous Residence

Street Address:

City:

State:

Zip Code:

Last Rent Amount Paid:

Owner / Manager:

Phone Number:

Is/Was rent paid in full:

Reason for Leaving:

Did you give notice?

Were you asked to move?

Name(s) in which your utilities are now billed?

Dates of Residency:

EMPLOYMENT HISTORY

EMPLOYMENT HISTORY

Current Employment

Current Employment

Employed By:

Address:

Employer's Phone:

Occupation:

Name of Supervisor:

Monthly Gross Pay:

Dates of Employment:

Previous Employment

Previous Employment

Employed By:

Address:

Employer's Phone:

Occupation:

Name of Supervisor:

Monthly Gross Pay:

Dates of Employment:

CREDIT HISTORY

CREDIT HISTORY

Savings Account:

Checking Account:

Credit Card:

Auto Loan:

VEHICLES (Include vehicles belonging to other proposed occupants also)

VEHICLES (Include vehicles belonging to other proposed occupants also)

Make:

Model:

Color:

Year:

License Plate:

Make:

Model:

Color:

Year:

License Plate:

REFERENCES & EMERGENCY CONTACTS

REFERENCES & EMERGENCY CONTACTS

Doctor

Doctor

Name:

Street Address:

City:

State:

Zip Code:

Phone Number:

Lawyer

Lawyer

Name:

Street Address:

City:

State:

Zip Code:

Phone Number:

Nearest Relative

Nearest Relative

Name:

Street Address:

City:

State:

Zip Code:

Phone Number:

Approval for Contacts

By signing the application you grant us permission to communicate with all the contacts listed in this section in the event we can't locate you. Furthermore, if you abandon the residence for any reason then you grant us permission to allow your relative listed above to remove all contents of the dwelling on your behalf.

GENERAL INFORMATION

GENERAL INFORMATION

Have you ever been served a late rent notice?

Yes

Have you ever filed for bankruptcy?

Yes

If so, when?

Have you ever been convicted of or plead guilty or "no contest" to offences relating to manufacturing / distribution / intent-to-distribute a controlled substance (weather or not resulting in a conviction)?

Yes

Have you ever been convicted of or plead guilty or "no contest" to a felony (weather or not resulting in a conviction)?

Yes

Have you ever been convicted of or plead guilty or "no contest" to a misdemeanor involving sexual misconduct (weather or not resulting in a conviction)?

Yes

Have you ever been served an eviction notice?

Yes

If so When?

Have you had any reoccurring problems with your current residence or landlord?

Yes

If yes, please explain:

How long will you be renting from us?

List any verifiable sources and amounts of income you wish to have considered (optional):

If you were to run into financial difficulty in the future and couldn't come up with the money to pay the rent, do you know someone that would loan you the money?

Yes

If so, provide the person's name, address, & phone # so that we can use them as a reference for you.

Have you been a party to a lawsuit in the past?

Yes

If yes, please explain why:

This application gives us authorization to run a credit check and a criminal background check (past, present or future). Is there anything negative we will find that you want to comment on?

How did you hear about this residence?

Do you know of anybody else looking for a residence? Please provide their name and number. If you refer a friend and you each end up renting separate residences from us then we will pay you a referral fee.

Agreement & Authorization

AGREEMENT & AUTHORIZATION

Agreement and Authorization

By Clicking this checkbox you agree to the following:

A separate application must be completed and signed by all parties responsible for rental payments agreed upon in the lease before it can be considered by BEN-STEELE PROPERTIES, LLC. Acceptance of this application and any monies deposited herewith, is not considered binding upon BEN-STEELE PROPERTIES, LLC. This non-refundable application fee is $25.00 to cover the cost of processing the application. If your application is denied, the application fee is non-refundable and all other monies are refundable. If the applicant withdraws the application after notification of acceptance, all monies including deposits will be retained by BEN-STEELE PROPERTIES, LLC. Refer to the Minimum Criteria for Resident Selection attached for additional considerations with the application.

In signing this application, I declare that all of my responses are true and complete. I authorize BEN-STEELE PROPERTIES, LLC and/or its agents to verify this information in the past, present or future including written credit report and/or criminal check and communication with any and all names listed on this application for use in the resident screening procedures. This release is given and my consent and acknowledgement is granted by my signature below. This application does not constitute a rental or lease agreement which will be signed upon approval of this application at the discretion of BEN-STEELE PROPERTIES, LLC. Any false statements on this application can lead to rejection of your application or immediate termination of your lease.

2200 E. Sunshine Suite 205, Springfield MO 65804-1924, United States | +1 417 882 0690