STERLING PROPERTIES, LLC
RENTAL APPLICATION – PRINT ALL THEN FAX TO 336-510-8609
Name _____________________________________________Soc. Sec. No._________________
Telephone ________________ Fax _________________ Driver’s License No. __________________
Present Address _________________________________________________________________
City________________________________________ State _________ Zip _________________
How long at present address _______________________________ Date of Birth__________________
Name of Landlord _________________________________Telephone ______________________
Prior Address ____________________________________________________________________
City___________________________________________ State _________ Zip _______________
How long at prior address _________________________________
Name of Landlord _______________________________Telephone __________________________
How many people will be living in this unit? Adults ____Children _____Pets ____ Weight of Pets ____
Employer _______________________________________ Position __________________WK Pay_______________(please FAX pay stub)
How long employed _________________________ Telephone __________________________
Name ____________________________________SS# ____________________________________
Telephone ______________________ Driver’s License No. __________________________
Employer ______________________________________ Position ________________________
How long employed _______________________ Telephone ____________________________
Name_________________________ Relationship_________________Telephone_____________________
Automobile: Make/Model__________________ Color_____________________ TAG_________________ State___
HAVE YOU EVER:
Filed for Bankruptcy _____Yes _____No If yes, when _________________
Been served an eviction notice or been asked to vacate a property you were renting ___ Yes ___ No
Willfully or intentionally refused to pay rent when due ___ Yes ___ No
I am a registered student at __________________________________________
Payment Option: 12 month lease_____ Academic Year______
Billing Option: Advance ______ Semester_____ Installments_______
Moving in Option: January _____ May_______ August_______ Other_____
Please Choose: College Park_______ Westbrook_____ University Manor_______ Other________
Roommates Name: (if known) ____________________________________________________________________________________
Move In Date:______________________________________________________---
Rental Unit applied for_____________________________________________________________________
Commencement Date ______________ Term _______________________ Rent/Month _________________
Radon Gas – Notice to Prospective Tenant: Radon is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines have been found in buildings in this state. Additional information regarding radon and radon testing may be obtained from your county public health unit.
Lead Paint – Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The seller of any interest in residential real estate is required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspection in the seller’s possession and notify the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase.
I/We, the undersigned, understand that Four Corners Realty is the leasing agent and representative for the owner/landlord and that the leasing agent’s fees will be paid by the owner/landlord. The undersigned acknowledge that this written notice was received prior to the undersigned receiving a lease agreement.
I/We declare the foregoing information is true and correct, and I/We hereby authorize you to conduct an employment and credit check and to verify our references.
_________________________________________ ________________________________________
Applicant’s Signature Date Co-Applicant’s Signature Date