MBD Apartments Tennant Application

Which address are you applying for? *
Move In Date? *

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First Name *
Middle Intl. *
Last Name *
Birth Date mm/dd/yy *
Telephone Number *
Email Address
Social Security # *
Drivers Lic. # *

Current Address (Street/City/State/Zip) *
Length of Residence? *
Current Landlord & Phone Number (If Applicable)
Prior Address (Street/City/State/Zip)
Length of Residence?
Previous Landlord & Phone # (If Applicable)
Employer & Employers Address *
Income (indicate if hourly or annual) *
Supervisors Name
Employer Phone *
Job Title *
Length at Company *
Previous Employer if less than 2 years at current company (name, address, phone & supervisor)
Have you ever been convicted of a crime? *

Spouse Information If Applicable (Please skip to the next page if you are not married).
First Name
Middle Intl.
Last Name
Spouse's Birth Date mm/dd/yy
Socail Security #
Drivers Lic. #
Spouses Employer (Name, Address, Phone #)
Supervisors Name
Income (Indicate if Hourly or Annual)
Previous Employer if less than 2 years (Name, address, phone & salary)
Has your spouse ever been convicted of a crime? *

How Many People will be living in this Unit? *
# of Adults
# of Children
Sorry, but NO PETS are allowed in any units owned by MBD Apartments.
Any Vehicles? Make, Model, Year, Color & Tag #'s
Add. Vehicles - Make, Model, Year, Color & Tag #'s

Bank, Credit & References Section (Please list referrences NOT LIVING WITH YOU)
Personal Referrence #1 (Name, Relationship & Phone#) *
Personal Referrence #2 (Name, Relationship & Phone#) *
Have You Ever Filed Bankruptcy? *
If Yes, When?
Have you ever been served an eviction notice or been asked to vacate a property you were renting? *
Have you Even willfully or intentionally refused to pay rent when due? *
If Yes, When?
DISCLOSURE INFORMATION:
RADON GAS – Notice to Prospective Tenant: Rason 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 every state. Additional information regarding rason 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 or interest in residential real estate is required to provide the buyer with any information on lead-based paint hazards from risk assesments 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.
ACKNOWLEDGMENT:
I/We, the undersigned, understand that MIKE DeMINTER 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.
CONSENT TO OBTAIN CREDIT / EMPLOYMENT INFORMATION:
I/WE authorize MIKE DeMINTER, to investigate my/our credit qualifications and hereby release, in any manner, all of the information obtained by you. I/WE further release all persons, agencies, or firms from any liabilities resulting from providing such information.
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I/WE declare under penalty of perjury that the information listed in the application is true and correct. Executed on:
on this date *

- Month - Day Year
at
: Hour Minutes
In the City of, *
In the State of, *
By typing your name below, you are herby signing this document and authorizing MIKE DeMINTER and MBD Apartments to review this application and perform a background, credit, criminal and referrence checks.
Primary Applicants Signature (TYPE FULL NAME) *
Co-Applicatings Signature (If Applicable Type Full Name)
E-mail
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