APPLICATIONFORLEASE& AUTHORIZATIONFORCREDIT/BACKGROUNDCHECK

1LEASETERMS(IfAvailable)

2PremisesAddress

3Monthly Rental $SecurityDeposit $

4LeaseTermFrom To

5APPLICANT

6Name Contact Phone

7Submit separate applicationsfor each co-applicant. Indicatehere thenumberof additionalapplications, if any:

8PresentAddress

9E-MailAddress

10Social Security# Date ofBirth

11NumbertoOccupyPremises:Adults ChildrenUnder18 Pets

12Type Weight ofEachPet

13Nearest Relative(otherthananyco-applicant) Relation

14Address Phone

15CurrentLandlord Phone

16Address

17CurrentRent$LeaseExpires

18#ofYears atCurrentAddress SharingPremises?(checkone) Yes NoHowLong?

19ReasonforMoving

20PreviousAddress HowLong?

21PreviousLandlord Phone

22Address

23DoYouSmoke?(checkone) YesNo

24EMPLOYMENT

25Employer Years

26Address

27Position GrossAnnualIncome $

28Supervisor'sName Phone

29PreviousEmployer(ifcurrentemploymentisunder2years)

30Address Years

31Position GrossAnnualIncome $

32Supervisor'sName Phone

33ApplicantInitials:

34OTHER INCOME

35Source Amount$ Frequency

36Source Amount$ Frequency

37FINANCIALOBLIGATIONS(debtpayments,credit cards,judgments,alimony,child support,etc)

38Description Amount$ Frequency

39Description Amount$ Frequency

40Description Amount$ Frequency

41Description Amount$ Frequency

42BANK ACCOUNTS

43Bank Checking Savings

44Bank Checking Savings

45Bank Checking Savings

46VEHICLES

47Make/Model Year LicensePlate # State

48Make/Model Year LicensePlate # State

49Make/Model Year LicensePlate # State

50Yes No (checkone) Haveyoueverbeenaskedto leaveorbeen deniedtherenewalofalease?Ifyes,give details:

51

52

53Yes No(check one)Any litigation,priororpending,suchasevictions,suits,judgments,bankruptcies,foreclosures,

54criminalproceedings,etc?If yes,givedetails:

55

56Yes No(check one) Areyou orany intendedoccupantsasex offender, sexual predator or otherwise subjectto

57reportingrequirementsoftheIllinoisSexualOffenderRegistration Actorany similarlaw in any otherjurisdiction?

58$hasbeen paid for this credit/background check. THIS SUM IS NOT REFUNDABLE.

59Iauthorizeacredit check,investigationandcriminalbackgroundchecktobemadewhereby informationisobtained

60about my credit history and by interviewswithlandlordsand/or others withwhomI amacquainted.This inquirymay

61includeinformationasto my character,andgeneralreputation.I expressly authorize the resultsof the creditcheck and

62criminal background checkto be provided to theLandlord.I understandIhave arighttomakeawrittenrequestwithina

63reasonableperiodoftimetoreceiveadditional,detailedinformationaboutthe natureandscopeofthisinvestigation,

64includingcopiesofany reportsobtained by theLandlordin connectionwiththisapplication.

65I certify that Ihave readtheaboveapplication andthatthe informationcontained thereinis trueand correct. Iunderstand

66thatthisapplication shallbeincorporated into andbecomeapartof the lease forthePremisessought,andthatany false

67informationprovidedby meshall begroundsforcancellationofthelease.

68I expressly authorize thisapplication,thecreditreport andrelated informationto be provided to theLandlord, whomay

69use it to determinemy suitability asaTenantaspermittedorrequiredby law.

70

71SignatureofApplicantDate

72

73PrintApplicant'sName

74

75PrintPremisesAddress