P.O. Box 5143
Springdale, AR 72765
Web:  www.ElderCompany.com       E-mail:  Debby@eldercompany.com
Application Fee: $25 per Applicant
Applicant type: Individual   Co-Applicant
Address of the property you're applying for: 

Planned Move-in Date:

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Applicant Information
Personal Information
First:
Middle:
Last:
Date of Birth:
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SSN:
Home Number:
Cell Number:
Email:
Driver License #:
State:
Expires: Click Here
Automobile Information
Make:
Model:
Year:
Color:
License plate#:

Make:
Model:

Residential History
Current Address
Street1:
Street2:
City:
State: Zip:
Residency: Rent   Own
Previous Address
Street1:
Street2:
City:
State:
Zip:
Residency:
Rent   Own
Employment Information
Employer:
Address:
City:
State:
Zip:
Phone Number:
Title/ PayGrade:
Monthly Income:
Hire Date:
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Applicant Questions
Have you ever lived at Elder Management?
Yes   No
If so, date of tenancy? 

Have you ever been evicted from any tenancy?
Yes   No

Have you or your spouse ever willfully or intentionally refused to pay rent when due?
Yes   No

Explain: 

Have you or your spouse ever filed for bankruptcy?
Yes   No

If so, when? 

Have you or any member of your household been convicted of any felonies or misdemeanors (other than routine traffic offenses)?
Yes   No

Does any of the intended occupants smoke or use tobacco?
Yes   No

Will you own a pet?
Yes   No

What type of pet?

Breed? 

Weight? 

Other Occupants (Type a last name then hit Tab to get another line to add another occupant.  The maximum is six.)
Please list all people who will reside in the residence:
First: MI: Last: Relation: Date of Birth: SS#: Gender:

Emergency Contact:
Relationship to Applicant:
Name:
Phone Number:
Street1:
Street2:
City:
State: Zip:
Nearest Relative (Not residing in the apartment.):
Relationship to Applicant:
Name:
Phone Number:
Street1:
Street2:
City:
State: Zip:


Where did you hear about Elder Management?
Sign on Street

Elder Management Web Site

Other Internet Site


Other:

Financial Information
Bank and Credit Information
Bank NameAccount TypePhone
Credit Reference NameAccount TypeBalance


Additional Income
Income SourceMonthly Income
Pension
Social Security and/or SSI
Alimony
Child Support
AFDC/Government Assistance
Unemployment Compensation
Other
Do you own a home or other real estate? Yes   No
Additional Comments or Notes
Application Completion

ACKNOWLEDGEMENT:

I / we, the undersigned, understand that Elder Management is the leasing Company and has been hired by the Owner / Landlord to Manage Properties.  Elder Management and its employees and managers are solely representing the Owner / Landlord.  Elder Realty Group is a Licensed Real Estate Company.  Owner may be a Licensed Real Estate Agent.  The undersigned acknowledge that this written notice of such representation was received prior to the undersigned receiving a Lease Agreement.

CONSENT TO OBTAIN CREDIT / EMPLOYMENT / CRIMINAL INFORMATION

I / we authorize Elder Management, LLC to investigate, research and obtain my/our credit, employment and criminal qualifications and hereby release, in any manner, all of the information obtain therein.  I / we further release all persons, agencies, or firms from any liabilities resulting from providing such information.

The undersigned authorized Elder Management to contact the undersigneds current and/or previous landlord, employer, personal and credit references and further by copy of this Application, authorizes any said landlord or employer to release pertinent residential and employment history information to be used in evaluating my Application.  I/we further authorize Elder Management to apply for and/or obtain an investigation or credit report as well as a criminal background report in evaluating this Application.  I understand that said investigation or reports may contain information from various State, Governmental and private entities and may be relative to the undersigneds number of children, employment, occupation, general health, financial and criminal history.

I / we declare under penalty of fraud that the information listed in this application is true and correct.  False information is grounds for immediate nullification of the Lease Agreement.

Valid Photo Identification must be presented prior to final approval of this application.
I, the undersigned Applicant, agree to the above terms and do hereby swear (or affirm) that the information supplied herein is true and complete, to the best of my knowledge and belief.  By clicking "Apply Now" you agree to the terms stated above.  Please enter your full name to signify your digital signature, thereby confirming that you have read and agree with all the above statements and have provided complete and accurate information.  Applicant authorizes verification of references given and declares that the statements made in this application are true and correct and agrees that the landlord may terminate the contract entered into in reliance on any misstatement made in this application.

APPLICANT SIGNATURE: