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THE PREPARATION AND EXECUTION OF THIS AGREEMENT DOES NOT CREATE A TENANCY BETWEEN APPLICANT AND OWNER, NOR ANY INTEREST BY APPLICANT IN THE UNIT DESCRIBED. APPLICANT UNDERSTANDS THAT THE DEPOSIT GIVEN WITH THIS APPLICATION IS REFUNDABLE ONLY IF THIS APPLICATION IS NOT APPROVED AND FOR NO OTHER REASON. APPLICANT UNDERSTANDS THAT THERE IS A NON-REFUNDABLE CHARGE FOR OBTAINING A CREDIT REPORT, KNOWN AS THE APPLICATION FEE OF $35.00.

BY SIGNING BELOW, I HEREBY AUTHORIZE THE UNDERSIGNED AGENT OF WEST USA REALTY TO REQUEST CREDIT INFORMATION FROM A THIRD PARTY SOURCE CHOSEN AT THEIR DISCRETION; TO REVIEW OUR CREDIT RATING, CRIMINAL BACKGROUND CHECK FOR A LEASE OF A HOME AND TO RELEASE THIS INFORMATION TO THE LANDLORD AND THEIR COUNSEL AND WILL NOT BE USED FOR ANY OTHER PURPOSE.

ANY FALSE INFORMATION GIVEN IN THIS APPLICATION WILL AUTOMATICALLY RESULT IN REFUSAL OF APPLICATION TO RENT OR TO TERMINATE ANY SUBSEQUENT TENANCY. THE ABOVE INFORMATION IS TRUE AND CORRECT. OWNER OR OWNER'S AGENT IS HEREBY AUTHORIZED TO VERIFY BY MEANS OF A CREDIT REPORT AND BY CONTACTING PREVIOUS AND PRESENT LANDLORD'S AND OTHERS. PERSONAL CHECKS ARE NOT ACCEPTABLE FOR PAYMENT OF MOVE-IN COSTS.

DATE_____________________ APPLICANT________________________________________________________

DATE_____________________ APPLICANT________________________________________________________

APPROVED___________ REJECTED___________ BY________________________________________________

PROPERTY ADDRESS__________________________________________________________________________

OWNER______________________________________________________________________________________

LEASE TERM __________________________
BEGINS____________ENDS______________
MONTHLY RATE_______________________
PRO-RATED AMOUNT Y____ N____

FIRST MONTH _________________________
DEPOSIT _____________________________
TOTAL ______________________________

DEPOSIT TO HOLD _____________________

BALANCE DUE PRIOR TO POSSESSION ________
BALANCE DUE ___________ DAYS @ _________

THE UNDERSIGNED AGENT HEREBY UNDERSTANDS THAT THE CREDIT REPORT BEING REQUESTED IS NOT TO BE SHOWN TO THE CONSUMER. THE REPORT IS STRICTLY FOR THE BENEFIT OF THE LANDLORD.

AGENT SIGNATURE_______________________________________________________________________________________________

West USA Realty Flagstaff
2500 S. Woodlands Village Blvd #3 • Flagstaff, AZ 86001
Cell: (928) 699-3445 • Fax: (928) 779-2751
Direct Line: (928)526-5394
Office: (928)779-5354

Input Your Information
* Name
* Email
* Social Security #__ Birthdate__ DL#__
* Phone #1
* Co-Applicant Name
* Co-Appl. S Security #__ Birthdate __ DL# __
* Phone #2
* Present Address/City/State/Zip
* How Long? Reason for Leaving?
* Present Landlord/Address/Telephone Number/Amount of Rent
* Employer
* How Long?/Position?/Salary per Month?/ Phone #
* Co-Applicant Employer
* Co-Appl. How Long?/Position?/Salary per Month?/Phone
* Bank/Branch/Checking Acct #
* Bank/Branch/Savings Acct#
* Vehicles/Make/Model/Year/Color/License#
* Co-Appl. Vehicle/Make/Model/Year/Color/License#
Number and Kind of Pets
Person to Notify in Case of Emergency/Name/Address/Phone#
Names of ALL Occupants, Including Children
Relationship/Age/Driver's Lic.#
Relationship/Age/Drivers Lic.#
Relationship/Age