Flugel Properties, LLC www.flugelproperties.com Page 1 of 6

RESIDENTIAL RENTAL APPLICATION

Property Address Rental Amount

Heat Electricity Water W/D Other

Security Deposit 1 months’ rent Earnest Money $100 Lease Term 1 year

COMPLETE THE FOLLOWING FOR EACH PERSON WHO WILL OCCUPY THE UNIT:

Name Relationship Birthdate w/ year

CONTACT INFORMATION FOR ADULT APPLICANTS:

First name Email Phone (is this a home or cell number?)

COMPLETE THE FOLLOWING FOR ALL VEHICLES THAT WILL BE KEPT ON PREMISES:

License plate # State Make, model, year


HOUSING REFERENCES (Must include 2 landlord references and housing for past 3 years)

Rental Address 1

From ______To ______Rental Amount

Landlord Name Landlord phone

Landlord Email Landlord fax

Landlord Address ______

Rental Address 2

From ______To ______Rental Amount

Landlord Name Landlord phone

Landlord Email Landlord fax

Landlord Address ______

Rental Address 3

From ______To ______Rental Amount

Landlord Name Landlord phone

Landlord Email Landlord fax

Landlord Address ______

Rental Address 4

From ______To ______Rental Amount

Landlord Name Landlord phone

Landlord Email Landlord fax

Landlord Address ______

EMPLOYMENT

Income information—INCLUDE ALL SOURCES OF INCOME

PLEASE LIST EMPLOYMENT REFERENCES COVERING THE PAST 2 YEARS

Employer______Position ______

Employer Address ______

Phone # (____)______Supervisor Name ______From _____ To _____

Amount of Income ______/Year ______/Month ______/Hour

Employer______Position ______

Employer Address ______

Phone # (____)______Supervisor Name ______From _____ To _____

Amount of Income ______/Year ______/Month ______/Hour

Employer______Position ______

Employer Address ______

Phone # (____)______Supervisor Name ______From _____ To _____

Amount of Income ______/Year ______/Month ______/Hour

Employer______Position ______

Employer Address ______

Phone # (____)______Supervisor Name ______From _____ To _____

Amount of Income ______/Year ______/Month ______/Hour


PERSONAL REFERENCES (DO NOT LIST RELATIVES AS REFERENCES)

Name ______

Full Address ______

______

Phone (____) ______Relationship ______Years known ______

Name ______

Full Address ______

______

Phone (____) ______Relationship ______Years known ______

Name ______

Full Address ______

______

Phone (____) ______Relationship ______Years known ______

EMERGENCY CONTACT (Please list someone in the area if possible)

Name ______

Full Address ______

______

Daytime phone (____) ______Evening phone (____) ______

Relationship ______Years known ______


ANSWER EACH OF THE FOLLOWING QUESTIONS YES OR NO

You may attach additional sheets of paper for explanation if necessary

Y N Any other source of income not listed?

Explanation: ______

Y N Social Security, SSI, or any other payment from Social Security Administration?

Explanation: ______

Y N Do you have full custody of your child/children?

Explanation of custody arrangements: ______

Y N Do you expect any additions to the household within the next 12 months?

Explanation: ______

Y N Have you ever filed for bankruptcy?

Explanation: ______

Y N Have you ever been convicted of a felony?

Explanation: ______

Y N Have you ever been evicted from an apartment for any reason?

Explanation: ______

All questions that were answered Yes will be verified through the appropriate third-party source. It is your responsibility to provide Michael Piette with all necessary information to properly process your application and verify your eligibility. This will include names, addresses, phone numbers and account numbers where applicable and any other information required to expedite this process.


SIGNATURE CLAUSE

I understand that Flugel Properties is relying on this information to prove my household’s eligibility for renting an apartment from them. I certify that all information and answers to the above questions are true and complete to the best of my knowledge. I consent to release the necessary information to determine my eligibility. I understand that providing false information or making false statements may be grounds for denial of my application. I also understand that such actions may result in criminal penalties.

I authorize my consent to have Flugel Properties (Michael Piette, manager) verify the information contained in this application for purposes of proving my eligibility for occupancy. I will provide all necessary information and expedite this process in any way possible. I understand that my occupancy is contingent on meeting Flugel Properties’ resident selection criteria. I authorize Flugel Properties (Michael Piette, manager) to run a credit check on me.

Earnest Money Received $ 100 Date

Cash / Check made out to Flugel Properties LLC

If you are accepted the earnest money becomes a portion of the Security Deposit due. If you are not accepted, then your earnest money will be returned to you. If you are accepted and you change your mind you forfeit the earnest money held. At the time of entering into a rental agreement the applicant agrees to pay the balance due of the security deposit and the first month’s rent. If the applicant refuses to enter into a rental agreement after this application has been approved, actual costs and damages incurred will be deducted from the deposit. Deposits may also be withheld as compensation for lost rent if the landlord makes reasonable effort to mitigate the rental loss in accordance with 704.29 Wisconsin Statutes.

For credit check: Social Security number and DL# for each adult that will occupy the unit:

Name Social Security Number Driver’s License # State

ALL ADULT HOUSEHOLD MEMBERS MUST SIGN BELOW:

Signature Date

Signature Date

Signature Date

Michael Piette, 712 E Court St, Janesville WI 53545.

Home: (608) 752-5276. Cell (608)772-2010. Email