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Get MA 485055 2010

PROSPECTIVE TENANT INFORMATION FORM Please complete a separate Application for each adult occupant other than a spouse. IDENTIFICATION/LANDLORD REFERENCES Name Social Security No* Current Home Address Work Phone How long at current address Prior Address City/State/Zip Name of Spouse Spouse Driver s License No* Names Of Other Occupants Vehicle Make Check If 18 Years Driver s License No* Home Phone State Animals/Pets Type And Number Landlord/Agent Name Phone How long Prior Landlord s Phone Year Model Age Soc*Sec* No* License No* Color EMPLOYMENT / INCOME INFORMATION Employer s Name Indicate if self employed and d/b/a Business Address Nature Of Business Position/ Title or occupation if self-employed Monthly Gross Income Prior Employer s Name Length of Employment Supervisor s Name PERSONAL AND CREDIT REFERENCES Bank No* 1 Name Address Savings Account No* Balance Checking Account No* Personal Reference No* 1 Name Nature Of Relationship Nearest Relative In Case Of Emergency Name ADDITIONAL INFORMATION / AUTHORIZATION Have you ever failed or refused to pay any rent when due Have you ever had an eviction notice served on you If yes when Explain situation and outcome Has a landlord ever claimed that you damaged his property If yes when Within the past seven years have you filed a petition of bankruptcy Have you ever been convicted of a felony Explain If yes date s AUTHORIZATION* I authorize the Landlord or agent to contact all references listed above to obtain information about me and to obtain a copy of my credit report and criminal offender record information CORI if available. If my application is denied based upon my credit report I will be informed of the specific reason* I agree that the Landlord may terminate any tenancy made in reliance on any misstatement made in this Application* I understand that there is no agreement to rent until a lease/tenancy agreement is signed by Landlord. I AFFIRM THAT THE FOREGOING IS TRUE AND CORRECT UNDER THE PAINS AND PENALTIES OF PERJURY. DATED Applicant 1999 2010 MASSACHUSETTS ASSOCIATION OF REALTORS 5. 04. 10/485055 Massachusetts Association of REALTORS 256 Second Ave Waltham MA 02451 Phone 781. 839. 5520 Fax 781. 839. 5570 Michael McDonagh Produced with zipForm by zipLogix 18070 Fifteen Mile Road Fraser Michigan 48026 www. IDENTIFICATION/LANDLORD REFERENCES Name Social Security No* Current Home Address Work Phone How long at current address Prior Address City/State/Zip Name of Spouse Spouse Driver s License No* Names Of Other Occupants Vehicle Make Check If 18 Years Driver s License No* Home Phone State Animals/Pets Type And Number Landlord/Agent Name Phone How long Prior Landlord s Phone Year Model Age Soc*Sec* No* License No* Color EMPLOYMENT / INCOME INFORMATION Employer s Name Indicate if self employed and d/b/a Business Address Nature Of Business Position/ Title or occupation if self-employed Monthly Gross Income Prior Employer s Name Length of Employment Supervisor s Name PERSONAL AND CREDIT REFERENCES Bank No* 1 Name Address Savings Account No* Balance Checking Account No* Personal Reference No* 1 Name Nature Of Relationship Nearest Relative In Case Of Emergency Name ADDITIONAL INFORMATION / AUTHORIZATION Have you ever failed or refused to pay any rent when due Have you ever had an eviction notice served on you If yes when Explain situation and outcome Has a landlord ever claimed that you damaged his property If yes when Within the past seven years have you filed a petition of bankruptcy Have you ever been convicted of a felony Explain If yes date s AUTHORIZATION* I authorize the Landlord or agent to contact all references listed above to obtain information about me and to obtain a copy of my credit report and criminal offender record information CORI if available. If my application is denied based upon my credit report I will be informed of the specific reason* I agree that the Landlord may terminate any tenancy made in reliance on any misstatement made in this Application* I understand that there is no agreement to rent until a lease/tenancy agreement is signed by Landlord. .

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