I have read and agree to the Application Agreement. Click Here to read Application Agreement.
Application Fees are $30.00 per person over the age of 18 in the household.
(NOTE:  An application will not be processed until fees are received.)
Property Information
Property Address:
Date Visited:
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Date you will take occupancy:
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Date Submitted

04-19-2024
Applicant type: Individual   Individual w/Guarantor
Applicant Information
Personal Information
First:
Middle Initial:
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#:
State:

Make:
Model:
Year:
Color:
License plate#:
State:

Any other name(s) used (including maiden name): 
Residential History
Current Address
Street1:
Street2:
City:
State: Zip:
Residency: Rent   Own
Previous Address
Street1:
Street2:
City:
State:
Zip:
Residency:
Rent   Own
Employment Information
Employment Status
Full-Time   Part-Time   Retired   Student   Self-Employed   Unemployed  
If Retired, Student, Self-Employed or Unemployed what is your Monthly income?
Current Employer
Employer:
Address:
City:
State:
Zip:
Phone Number:
  Ext:
Supervisor Name:

Supervisor Number:
  Ext:

Your Title/Position:

Monthly Income:
Start Date:
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Previous Employer
Employer:
Address:
City:
State:
  Zip: 
Phone Number:
  Ext:
Supervisor Name:

Supervisor Number:
  Ext:

Your Title/Position:

Monthly Income:
Start Date:
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End Date:
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Applicant Questions
Have you ever been asked to move out of a residence?
Yes   No

Have you ever been party to an eviction?
Yes   No
Are you a registered sex offender?
Yes   No
Have you or any member of your household been convicted or pleaded no contest to a felony?
Yes   No


Are you aware of any facts or circumstances that you, your personal property, or your current or previous residences were exposed to bed bugs?
Yes   No




Do you have liquid furniture? (i.e. waterbed)
Yes   No

Do you have renter insurance?
Yes   No
Have you ever filed bankruptcy?
Yes   No
Have you ever had any collections?
Yes   No
Have you been exposed to bed bugs within the last two (2) years?*
Yes   No

*If you have been exposed to bed bugs, and are unwilling to give the above representations, warranties, and authorizations, your application could be denied.

Do you receive any of the following: Supplemental Security Income, Social Security Disability Insurance under Title II of the Federal “Social Security Act”, 42 U.S.C. Sec. 401 et seq., as amended, or Cash Assistance through the Colorado Works Program Created in Part 7 of Article 2 of Title 26?
Yes   No
Pets
Do you have Pets?
Yes   No
Occupants
Will there be other occupants living in the residence?
Yes   No

Emergency Contacts
Emergency Contact
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:
Nearest Relative (Not residing in the property.)
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:

Personal Reference
First:
Middle:
Last:
Phone:
E-mail:
Financial Information
Do you own a home or other real estate? Yes   No

Bank NameAccount TypePhone
Credit Reference NameAccount TypeBalance
Additional Income SourceMonthly Income
Pension
Social Security and/or SSI
Alimony
Child Support
AFDC/Government Assistance
Unemployment Compensation
Other (Please Specify)
Additional Comments or Notes
Application Completion

DISCLOSURE AND AUTHORIZATION

I hereby authorize ERS Management, LLC (Owner) and any of its subsidiaries to contact any governmental agencies, present and past employers, landlords, schools, law enforcement agencies, and others, with regard to inquiries pertaining to my character, general reputation, personal characteristics and credit standings. I further understand and authorize Owner to obtain and use consumer report information relating to me, including, but not limited to, credit score. The purpose of which is to establish that such characteristics would not adversely affect the physical environment, interfere with the health and safety of other residents or affect the financial stability of Owner and any assets managed by such.

Any false statement on the application may lead to the rejection of this application and/or immediate termination of the lease. Further, if conduct is discovered subsequently which would result in a “yes” response to any of the questions set forth above, even after the lease is signed, it is understood that the Owner may terminate the lease and proceed with eviction. Denied applications and approved applications that do not complete the move in process; will be held for 60 days after submission. After 60 days the application and any submitted items provided by applicant will be destroyed.

Investigational Background Search Disclosure

Alpine Realty and Management conducts applicant screening on persons applying to live in our managed properties, such screenings may include criminal background investigations.  Prior to acceptance of an applicant, we may use an independent consumer reporting agency to search public records which may contain criminal background information regarding the applicant.  Alpine Realty and Management will determine if the criminal background information pertains to the applicant and if the report indicates that one or more such felony and or misdemeanor records were found.  We will then compare the records to our established acceptance policies to determine whether or not the applicant may be accepted.  If your application is declined based on the discovery of public records that indicate an unacceptable criminal background, you will be given the name, address, and telephone number of the consumer reporting agency that provided the criminal background report.  An applicant who is declined based on a criminal background may obtain a free copy of the report and may initiate a reinvestigation to have any erroneous information contained in the report corrected.  The consumer reporting agency will advise you of the procedures that you should follow in order to do so.

Brokerage Relationship Disclosure

Alpine Realty and Management (“Broker” or “Agent” or “Landlord”) and the Prospective Resident(s) referenced in this application have NOT entered into any Real Estate Brokerage Agency Agreement or Relationship. The working relationship between Broker and Prospective Resident(s) is for a specific property described at the top of the application.

Resident understands and acknowledges that Broker is the agent for the property owner (Landlord), and Broker represents only the Landlord’s interests in this transaction. The Owner (Landlord) of the property has granted to Broker the authority to manage and administer the Premises and Property and to enter into, administer and enforce provisions of this Application and any subsequent Lease that may result from the approval of this Application, and Broker is not considered an agent for the Resident/Applicant at any time for any reason. As a prospective Resident, you are a customer in this transaction. A customer is a party to a real estate transaction with whom the Broker has no brokerage relationship because such party has not engaged or employed the Broker, either as the party's agent or as the party's transaction-broker. If you desire representation, Broker recommends that you obtain either your own Broker or legal advice from an attorney.

Different brokerage relationships are available that include seller agency, landlord agency, buyer agency, tenant agency or transaction-brokerage. The Colorado Real Estate Commission has a form setting forth the definitions of these working brokerage relationships (Form DD25). Upon request, Broker will provide the working definitions of the various brokerage relationships to you.



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: 




   
Database Info:  ALPINERT_132059  ARM_alpine