Accent Properties

2120 Corporate Square Boulevard #20

Jacksonville, Florida32216

9047217822 FAX 904-721-0711

E-mail:

Web page

Rental Property Application

Date ______Rental Address______

Anticipated Move in Date______Rental Amount$______

Application Amount$______Pet Fee(if allowed)$______per pet

Name ______Date of Birth ______

Social Security #______

Drivers License #______State______

Spouse/Other Occupant:

Name ______Date of Birth______

Social Security #______

Drivers License #______State______

Name of other persons occupying this residence:

Name:______Relationship______DOB_____

Name:______Relationship______DOB_____

Name:______Relationship______DOB_____

Name:______Relationship______DOB_____

Home Phone#______Work#______

Cell Phone#______Cell Phone #______

Email address______Email address______

Residence for last three (3) Years (Current First)

(1)______

Street Address City State Zip

______

How long Landlord’s name Phone Rent rate

Reason for leaving______

(2)______

Street Address City State Zip

______

How long Landlord’s name Phone Rent rate

Employment Information

(1)______

Name of employer Occupation Income

______

Address Supervisor Phone

(2)______

Name of employer Occupation Income

______

Address Supervisor Phone

Automobile Information

Type______Year______License #______St.______

Type______Year______License #______St.______

Pet Information

Do you own a pet? Yes___ No___ How many______Type______

Weight______Color______

If you do not have a pet, do you anticipate getting one? Yes____ No____

If yes, Management is requesting all information before its presence on the property. Approval must first be obtained in writing from owner.

Application Fees

Single person or married couple is $70.00,a $30.00 additional charge, for all non-student persons over 18 years of age. Application fees are non-refundable.

Acknowledgment

Receipt of application and fee from applicant is acknowledged as a processing charge. Acceptance of application with fee and any other monies deposited herewith are not binding upon Landlord until application has been approved by the owner of said rental property.

If applicant fails to execute a rental agreement or refuses to occupy premises on agreed upon date, all monies give shall be retained by owner of rental property as liquidated damages. If applicant is not approved, all monies given to agent less processing charge, shall be returned to applicant.

Applicant Initial______Applicant Initial______

Authorization

I/We certify that the information given herein is complete, true and

correct. Landlord or his agent is hereby expressly authorized to verify

the accuracy and correctness of this application, to communicate with my/our employer and creditors and to procure such other information which Landlord or agent may be required to evaluate this application.

This application must be signed before it can be processed. Any false information will constitute grounds for rejection.

Applicant Initial______Applicant Initial______

Agency Disclosure

The Realtor, as agent for the Property Owner, will be paid by the property owner as a fee for professional servicesrendered. Because of

fiduciary relationship, the Realtor represents the property owner.

The Realtor also has the legal and ethical duty to treat the Tenant with honesty, integrity, and fairness. The undersigned Applicant acknowledges that this disclosure was made prior to the execution of any contract for real property in question.

Applicant Initial______Applicant Initial______

Radon Gas Disclosure

Radon gas is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantity, may present health risks to persons who are exposed to it over a period of time. Levels of radon gas that exceed Federal and State guidelines have been found in buildings in the state of Florida. Additional information regarding radon and radon testing may be obtained from your county public health agency

Applicant Initial______Applicant Initial______

NO Smoking

Smoking is prohibited on the entirety of the property

Applicant Initial______Applicant Initial______

______

Applicant Date

______

Applicant Date