RENT-TO-OWN APPLICATION

Authorization is hereby granted to DR Investment Properties to obtain a standard factual data credit report from a reporting agency chosen by DR Investment Properties.

By submitting this form I authorize the release to the credit reporting agency, a copy of my credit application and I authorize the credit reporting agency to obtain information regarding my employment, bank accounts, prior rental history, background check and any outstanding credit accounts (i.e. mortgages, auto loans, personal loans, credit cards, credit unions, etc.). Authorization is further granted to the reporting agency to use a photostatic reproduction of this authorization if necessary to obtain any information regarding the above mentioned information.

If applicant(s) request a copy of the credit report obtained with any possible derogatory information to be sent to the address of present residence, applicant(s) will hold DR Investment Properties and any credit reporting organization harmless in so mailing the copy requested.

Any reproduction of this credit report authorization and release made by reliable means (for example, photocopy or facsimile) is considered original. Authorization is also granted for DR Investment Properties to release any information to the landlord/optionor for qualification purposes (if applicable).

NOTE: If more than one person over the age of 18 will be living in a property, please submit an application for each person.

APPLICANT INFORMATION

* = required information

* Address Applied For:

* First Name :

Middle Name :

* Last Name :

Maiden Name or Other Aliases :

* Date Of Birth (mm/dd/yyyy) :

* Social Security Number (###-##-####) :

Driver's License Number :

Driver's License State :

* Phone (###-###-####) : Invalid format.

Alternate Phone (###-###-####) : Invalid format.

* E-mail Address :

RESIDENCE HISTORY

Current Residence

* Street Address :

* City :

* State :

* Zip Code :

How long have you been at this address ?

* From (mm/yy) :

* To (mm/yy) :

Own or Rent ? Own Rent N/A

* Current Monthly Rent or Mortgage Payment :

If renting, Landlord's Name :

Landlord's Phone Number : Invalid format.

Is your current lease complete ? Yes No N/A

If current lease not complete, when does it expire ?

* Why do you wish to move from your current address ?

Previous Residence

Street Address :

City :

State :

Zip Code :

How long at previous address :

From (mm/yy) :

To (mm/yy) :

Own or Rent ? Own Rent N/A

Previous Monthly Rent or Mortgage Payment :

If rented, Landlord's Name :

Landlord's Phone Number : Invalid format.

Reason for leaving :

Prior Residence

Street Address :

City :

State :

Zip Code :

How long at prior address :

From (mm/yy) :

To (mm/yy) :

Own or Rent ? Own Rent N/A

Prior Monthly Rent or Mortgage Payment :

If rented, Landlord's Name :

Landlord's Phone Number : Invalid format.

Reason for leaving :

EMPLOYMENT HISTORY

Current Employment

Employer :

Street Address :

City :

State :

Zip Code :

Phone Number : Invalid format.

Your Position/Job Title :

Name of Supervisor :

How Long at Current Employer :

From (mm/yy) :

To (mm/yy) :

Gross Monthly Income :

Previous Employment (or 2nd job, if applicable)

Employer :

Street Address :

City :

State :

Zip Code :

Phone Number : Invalid format.

Your Position/Job Title :

Name of Supervisor :

How Long at Previous Employer :

From (mm/yy) :

To (mm/yy) :

Gross Monthly Income :

Prior Employment (or 3rd job, if applicable)

Employer :

Street Address :

City :

State :

Zip Code :

Phone Number : Invalid format.

Your Position/Job Title :

Name of Supervisor :

How Long at Prior Employer :

From (mm/yy) :

To (mm/yy) :

Gross Monthly Income :

ADDITIONAL SOURCES OF INCOME

	Source	Monthly Income	Contact Name	Phone Number
1.
2.
3.
4.

Any further additional monthly income ? Yes No

If yes, please list source(s), amount(s), contact name(s) and phone number(s) :

CREDIT HISTORY

Do you have a checking account ? No Yes

If yes, bank/institution name :

Do you have a savings account ? No Yes

If yes, bank/institution name :

Credit cards or other ? No Yes

If yes, details :

* Have you ever had your wages garnished ? No Yes

* Have you ever declared bankruptcy ? No Yes

* Have you had 2 or more late rental payments in the past year ? No Yes

* Have you ever been evicted ? No Yes

* Have you ever been in foreclosure ? No Yes

* Have you ever sold your house via short sale ? No Yes

*** If answered yes to any of the above, please list dates and details :

Applicant Debts
	Description	Total Balance	Monthly Payment
1.
2.
3.
4.
5.
6.
7.
8.

Any Additional Debts ? Yes No

If yes, please explain :

PERSONAL REFERENCES

	Name	Address	Phone
1.
2.
3.

List any additional references you would like to provide :

OTHER PROPOSED OCCUPANTS

List full names and ages of all children under 18 who would be residing with you :

All Other Proposed Occupants
	Name	Birthdate	Relationship to Applicant
1.
2.
3.
4.

Do you have any pets and/or service animals ? Yes No

If yes, what kind and how many ? Also indicate which are service animal(s), if any.

VEHICLES

(Include vehicles belonging to other proposed occupants)
	Make/Model	Color	Year	License Plate
1.
2.
3.
4.

ADDITIONAL INFORMATION

Do you have a waterbed ? Yes No

VA Eligible ? Yes No Unknown

* Do you have someone to co-sign the contracts ? Yes No N/A

* Where Did You Hear About Us ?

Additional Comments :
(Please give us any additional information that might help us to evaluate your application.)

I declare that all of the above information is accurate and correct. I authorize complete verification of this lease application and the obtaining of credit reports of all applicants. I further agree that the landlord or his/her agent may terminate any agreement entered into based on any misinformation contained in the lease application. Rental qualification credit check by Tenant Tracks (the tenant screening service we use) costs $25.99/person. Other options may be available. A representative will contact you for details. This website protected with SSL security to protect against hackers. All info is secure.