Web:  www.floridacoastalrentals.com       E-mail:  rentals@floridacoastaljax.com
I have read and agree to the Application Agreement. Click Here to read Application Agreement.
Application Fees are 50.00 per person over the age of 18 in the household.
(NOTE:  An application will not be processed until application fees
are paid and a copy of drivers license and proof of income are provided.)


Office Phone #: 904-249-7676
Fax #: 904-246-1010
E-mail Address: rentals@floridacoastaljax.com
Property Information
Property Address:
Choose your Agent:
Date you will take occupancy:
Click Here
Date Submitted

11-18-2017
Applicant type: Individual   Married Couple
Applicant Information
First:
Middle:
Last:
Date of Birth:
Click Here
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
Employer:
Address:
City:
State:
Zip:
Phone Number:
  Ext:
Personnel/HR Number:
  Ext:

Title/ Position:
Monthly Income:
Hire Date:
Click Here
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


Do you have renter insurance?
Yes   No
Have you ever filed bankruptcy?
Yes   No
Have you ever had any collections?
Yes   No
Do you have Pets?
Yes   No
Other Occupants (Type a last name then hit the Tab key to add another occupant.  The maximum is six.)
Please list all people who will reside in the residence, including minors:
First: MI: Last: Relation: Date of Birth: Click Here Gender:

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

Financial Information
Do you own a home or other real estate? Yes   No

Additional Income
Note: Documentation is required.
Income SourceMonthly Income
Pension
Social Security and/or SSI
Alimony
Child Support
AFDC/Government Assistance
Unemployment Compensation
Other
Additional Comments or Notes
Application Completion

DISCLOSURE AND AUTHORIZATION

The undersigned declares that the information on this rental application is true and correct, and understands that false statements may result in rejection of this and any future applications for housing we manage. The undersigned does further understand that all persons or firms associated with Florida Coastal Jacksonville Realty Inc may freely give any requested information concerning me. I waive all right to action for any consequences resulting from releasing such information.

I also hereby authorize Florida Coastal Jacksonville Realty Inc to verify my past and present employment earnings records, bank statements, previous residences and or any information given for the purposes renting and or lease through Florida Coastal Jacksonville Realty Inc including but not limited to a credit check. I further understand and agree that Florida Coastal Jacksonville Realty Inc will rely upon this Rental Application as an inducement for entering into a rental agreement or lease and I warrant that the facts contained in this Application are true. If any facts prove to be untrue, Florida Coastal Jacksonville Realty Inc may terminate my tenancy immediately and collect from me any damages incurred including reasonable attorneys fees resulting there from. You are also herein notified that a negative credit report reflecting your credit record may be submitted in the future to a credit reporting agency if you fail to fulfill the terms of your rental obligations or if you default in those obligations in any way. Florida Coastal Jacksonville Realty Inc welcomes all applicants and supports fair housing. We do not refuse to lease or rent any housing accommodations or property nor in any other way discriminate against a person because of sex, marital status, race, creed, religion, age, familial status, physical or mental handicap, color or national origin.

Notice is herby given of the contractual relationship between the Property Owner and Florida Coastal Jacksonville Realty Inc. Florida Coastal Jacksonville Realty Inc is an exclusive agent of the Property Owner and represents the Property Owner's interest in any and all rental transactions.

Investigational Background Search Disclosure

Florida Coastal Jacksonville Realty Inc conducts applicant screening on persons applying to live in our managed properties, such screenings may include criminal background investigations.  It's Florida Coastal Jacksonville Realty Inc's policy not to accept prospective residents who have been charged with and or convicted of certain felonies and or misdemeanors.  Prior to acceptance of an applicant, Florida Coastal Jacksonville Realty Inc may use an independent consumer reporting agency to search public records which may contain criminal background information regarding the applicant.  Florida Coastal Jacksonville Realty Inc 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.  Florida Coastal Jacksonville Realty Inc will then compare the records to Florida Coastal Jacksonville Realty Inc's 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 to Florida Coastal Jacksonville Realty Inc.  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.

If applicant pays a full or partial deposit to hold property off market and is not approved for the property, you will be given notice of action explaining the denial and the security deposit paid in advance will be refunded to you within 5 business days. If you are approved for the property, the advanced security deposit paid is NON-REFUNDABLE.

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: