Heartland Hideaways LLC

Separate applications required from each applicant 18 and older. Must be filled out completely.

Address of Property:

Length of Term

From

To

APPLICANT

Full Name - including all names you use(d)

Email:

Work Phone:

Cell Phone

Social Security Number

Date of Birth

Drivers License Number

State

Vehicle Make

Model

Color

Year

License Plate Number/State

CO-APPLICANT

Full Name - including all names you use(d)

Email

Work Phone

Cell Phone

Social Security Number

Date of Birth

Drivers License Number

State

Vehicle Make

Model

Color

License Plate Number

State

ADDITIONAL OCCUPANTS

List full names of everyone, including children and ages, who live with you at least 50% of the time:

RESIDENTIAL/RENTAL HISTORY, MINIMUM 2 YEAR HISTORY

Current Address

City, State, Zip

Dates lived at address

Reason for leaving:

Landlord/Manager

Landlord/Manager's phone number

Previous address:

City, State, Zip

Dates lived at address

Reason for leaving

Landlord/manager

Landlord/manager's phone

Additional history if needed

APPLICANT EMPLOYMENT HISTORY, MINIMUM 2 YEAR HISTORY

Name of current employer

Address

City, State, Zip

Phone

Supervisor

Supervisor phone

Dates employed at this job

Position/title

Name of previous employer

Address

City, State, Zip

Phone

Supervisor

Supervisor's phone

Dates employed at this job

Position/title

INCOME

Gross monthly employment income (before deductions)

Average monthly amounts of other income (specify source and amount)

CO-APPLICANT EMPLOYMENT HISTORY, MINIMUM 2 YEAR HISTORY

Name of current employer

Address

City, State, Zip

Phone

Supervisor

Supervisor's phone

Dates employed at this job

Position/title

INCOME

Gross monthly employment income (before deductions)

Average monthly amounts of other income (specify source and amount)

CREDIT & FINANCIAL INFORMATION

Bank/credit accounts

Checking account (bank/credit union) name

Address

Savings account (bank/credit union) name

Address

Retirement/Brokerage account institution

Address

Other Accounts

Address

Auto loan creditor

Address

Personal loan

Address

Credit card, issuer

Address

Credit card, issuer

Address

Other obligations

MISCELLANEOUS

Describe the number and type of pets you want to have in the property

Describe water-filled furniture you want to have in the property

Do you smoke?

Yes
No

Have you ever filed bankruptcy?

Yes
No

Have you ever been sued?

Yes
No

Have you ever been evicted?

Yes
No

Have you ever been convicted of a crime?

Yes
No

Explain any "yes" listed above

REFERENCES AND EMERGENCY CONTACT

Personal reference

Relationship

Address

Phone

Personal reference

Relationship

Address

Phone

Professional reference

How known

Address

Phone

Emergency contact

Relationship

Address

Phone

Anything else you would like to explain or tell us:

I certify that all the information given above is true and correct and understand that my credit and/or rental agreement may be terminated if I have made any material false or incomplete statements in this application. I authorize verification of the information provided in this application from my credit sources, current and previous landlords and employers, personal and professional references. I also understand a background check and a credit check from a credit reporting service and a criminal background check may also be conducted. I have filled out and/or explained every section. Any omissions will automatically disqualify me. Everyone over 18 years of age must sign.

I certify and acknowledge information given is true

Yes
No

Electronic authorized signature of applicant

Electronic authorized signature of co-applicant