Web:  www.bhhshodnettcooper.com       E-mail:  melody@hcrega.com
Rental Policy New Application Print Completed Application Pay Application Fee
I have read and agree to the Rental Policy. Click Here to read Rental Policy.
Application Fees are 60.00 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:  
Earliest date you will take occupancy:
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Date Submitted

04-02-2023
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:
Year:
Color:
License plate#:

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
Current Employer
Employer:
Address:
City:
State:
Zip:
Phone Number:
  Ext:
Personnel/HR Number:
  Ext:

Title/ Position:
Monthly Income:
Start Date:
Click Here
Previous Employer
Employer:
Address:
City:
State:
  Zip: 
Phone Number:
  Ext:
Personnel/HR Number:
  Ext:

Title/ Position:
Monthly Income:
Start Date:
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End 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 liquid furniture? (i.e. waterbed)
Yes   No

Do you have renter insurance?
Yes   No
Have you ever filed bankruptcy?
Yes   No
Pets
Do you have Pets?
Yes   No
Other Occupants (Type a last name then hit Tab 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: 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
Bank NameAccount NumberPhone
Credit Reference NameAccount NumberBalance




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

Additional 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 Berkshire Hathaway HomeServices Hodnett Cooper Real Estate 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 Berkshire Hathaway HomeServices Hodnett Cooper Real Estate 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 Berkshire Hathaway HomeServices Hodnett Cooper Real Estate including but not limited to a credit check.  I further understand and agree that Berkshire Hathaway HomeServices Hodnett Cooper Real Estate 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, Berkshire Hathaway HomeServices Hodnett Cooper Real Estate 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.  Berkshire Hathaway HomeServices Hodnett Cooper Real Estate 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 Berkshire Hathaway HomeServices Hodnett Cooper Real Estate. Berkshire Hathaway HomeServices Hodnett Cooper Real Estate is an exclusive agent of the Property Owner and represents the Property Owner's interest in any and all rental transactions.

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: 




   
Web:  www.bhhshodnettcooper.com       E-mail:  melody@hcrega.com
Database Name:  HDC_Island