Rental Application

Community Apartment # Date # of Applicants

PART I

Applicant Work Phone Home Phone Date of Birth
SS # DL #
In case of emergency notify: Telephone:
Do you have any pets? If so, Type & Breed: Weight:

PART II RESIDENCE HISTORY

Applicant Present Address City, State Zip How Long?
Present Landlord Telephone Payment

PART III

APPLICANT EMPLOYMENT HISTORY CURRENT & PREVIOUS 2 YEARS

Name of Company Street Address City State How Long? Monthly Income Supervisor Telephone

TRANSPORTATION

Type of Auto Tag No. State

Have you ever been evicted? Yes No

I hereby authorize Brigham Apartments, LLC, any of their agents, to confirm the information listed in my application. This authorization includes, but is not limited to, employment verification, performing a background check and ordering a credit report from any credit reporting agency. Any false information given will result in rejection of this application.

By submitting this information, Applicant agrees that this application is a binding contract between Brigham Apartments, LLC and the persons listed on the application. Upon receipt of the application, Brigham Apartments, LLC will conduct a credit check and a criminal background check. Applicant acknowledges that this application is subject to the review and approval of Brigham Apartments, LLC and that Brigham Apartments, LLC has the sole discretion to decide if Applicant can rent this apartment. Applicant authorizes Brigham Apartments, LLC to confirm the information listed in the application, with Applicant’s employer, and any credit reporting agencies. Any false information given will result in rejection of this application.