First Name     
Middle Name
Last Name    
Social Security Number (000-00-0000)  
Date of Birth (00/00/0000)
Driver License Number   Driver License State
License Expiration Date (00/00/0000)
Home Phone (000-000-0000)    
Mobile Phone (000-000-0000)
Work Phone (000-000-0000 ext 0000)  
Fax Phone (000-000-0000)  
Email Address
Preferred Contact By Select Home Phone Mobile Phone Work Phone Fax Phone Email

Spouse First Name      
Spouse Middle Name 
Spouse Last Name    
Social Security Number (000-00-0000)  
Date of Birth (00/00/0000)
Driver License Number   Driver License State
License Expiration Date (00/00/0000)
Home Phone (000-000-0000)   
Mobile Phone (000-000-0000)
Work Phone (000-000-0000 ext 0000)  
Fax Phone (000-000-0000)  
Email Address
Preferred Contact By Select Home Phone Mobile Phone Work Phone Fax Phone Email

Current Address   Apt/Unit No. 
City State   Zip Code  
Own   Yes    Rent  Yes
If Renting Please Select "Yes" To Approve Rental History Check  Yes
Manager Name
Manager Phone (000-000-0000)   Manager Fax (000-000-0000)
Move In Date (00/00/000)   Move Out Date (00/00/0000)  
Reason For Move

Prior Address   Apt/Unit No.  
City   State   Zip Code  
Own   Yes    Rent  Yes
If Renting Please Select "Yes" To Approve Rental History Check  Yes
Manager Name
Manager Phone (000-000-0000)   Manager Fax (000-000-0000)
Move In Date (00/00/000)   Move Out Date (00/00/0000)  
Reason For Move

Pets? Yes   No   If "Yes" Describe Pets (kind, male/female, sprayed/neutered, age, size/lbs)

Self Employed? Yes   No
Employer
Address
City State   Zip Code  
Date Hired (00/00/0000)   Position
Employer Phone (000-000-0000)  
Supervisor Name
Monthly Income

Spouse Self Employed? Yes   No
Employer
Address
City State   Zip Code  
Date Hired (00/00/0000)   Position
Employer Phone (000-000-0000)  
Supervisor Name
Monthly Income

Other Source of Income (child support, alimony, housing assistance)

Monthly Amount
Person to Verify
Phone (000-000-0000 ext 0000)

Other Source of Income (child support, alimony, housing assistance)

Monthly Amount
Person to Verify
Phone (000-000-0000 ext 0000)

Please list financial institutions you currently use.
Name of Bank/Financial Institution
Address
City   State   Zip Code
Type of Accounts Checking Savings Market Account CD
(Hold down "Ctrl" key to click more than one)
Name of Other Bank/Financial Institution
Address
City   State   Zip Code
Type of Accounts  Checking Savings Market Account CD
(Hold down "Ctrl" key to click more than one)

Please list all your financial obligations including mortgages, auto loans, personal loans and credit cards
Loan 1   Monthly Payment
Loan 2    Monthly Payment 
Loan 3    Monthly Payment 
Loan 4    Monthly Payment 
Loan 5    Monthly Payment 

Please list all proposed occupants in addition to yourself and spouse
Name   Age
Name   Age
Name   Age
Name   Age
Name   Age
Name   Age

Please list closest family members not residing with you
Name
Address  Apt/Unit No.
City   State   Zip Code
Home Phone (000-000-0000)
Name2
Address  Apt/Unit No.
City   State   Zip Code
Home Phone (000-000-0000)

Please list personal reference
Name
Address  Apt/Unit No.
City   State   Zip Code
Home or Work Phone (000-000-0000 ext 0000)

Please list your personal vehicles
Vehicle Make   Model   Year
License Number   License State
Vehicle 2 Make   Model   Year
License Number   License State

Please answer the following questions
Have you or any occupant ever broken a lease? Yes   No
Date(s) (00/00/0000)
If "Yes" Give Details

Have you or any occupant ever been convicted of a felony or crime? Yes   No
Dates(s) (00/00/0000)
If "Yes" Give Details

Have you or any occupant ever been removed from a rental property by forcible detainer action or any other legal action?  Yes    No
Date(s) (00/00/000)
If "Yes" Give Details

Please enter the rental property you are applying for
Address
City   Occupancy Date (00/00/0000)

Please authorize credit card payment
Applicant Authorizes Payment of Select $35 For Individual $50 For Married Couple   Credit Card Select Mastercard Visa
Credit Card No
Expiration Date (00/0000)  
Zip Code Statement Is Mailed To (00000)

Please carefully read the following and approve Roselli Realty Application Terms

APPLICANT UNDERSTANDS THAT ROSELLI REALTY IS THE AGENT OF THE LANDLORD/OWNER EXCLUSIVELY. APPLICANT FURTHER UNDERSTANDS THAT OCCUPANCY IS LIMITED TO ONLY THOSE NAMES ON THIS APPLICATION. APPLICANT ACKNOWLEDGES THAT ALL INFORMATION ON THE APPLICATION IS TRUE AND ACCURATE. APPLICANT AUTHORIZES VERIFICATION OF ALL INFORMATION INCLUDING BUT NOT LIMITED TO CREDIT CHECKS, CRIMINAL CHECKS, EMPLOYMENT HISTORY AND RENTAL HISTORY BY ROSELLI REALTY AND/OR ITS EMPLOYEES OR AGENTS.  APPLICANT GIVES PERMISSION TO ROSELLI REALTY AND/OR ITS EMPLOYEES OR AGENT TO CONTACT THEIR REAL ESTATE AGENT, IF ANY, IN CONNECTION WITH APPLICANT'S APPLICATION, CREDIT HISTORY AND RENTAL HISTORY. ANY FALSE INFORMATION LISTED SHALL CONSTITUTE GROUNDS FOR REJECTION OF THIS APPLICATION, TERMINATION OF THE RENTAL AGREEMENT AND ANY RIGHTS OF OCCUPANCY AND THE FORFEITURE OF ALL PAYMENTS AND DEPOSITS.

APPLICANT UNDERSTANDS THE PROCESSING FEE  IS NOT REFUNDABLE . IF APPLICANT IS NOT APPROVED. THE APPLICATION FEE WILL NOT BE REFUNDED. IF APPLICANT IS APPROVED BUT FAILS TO ENTER INTO THE RENTAL AGREEMENT IN A TIMELY MANOR OR FAILS TO TAKE OCCUPANCY ON THE DATE SPECIFIED IN THE RENTAL AGREEMENT, ANY EARNEST MONEY, GOOD FAITH DEPOSITS OR SECURITY DEPOSITS WILL NOT BE REFUNDED.

PAYMENTS CAN BE MADE ONLY WITH CASH, CASHIERS CHECK OR CREDIT CARDS. NO PERSONAL CHECKS ARE ACCEPTED.

APPLICANT MUST TYPE IS "YES" BELOW TO SUBMIT APPLICATION.

I(WE) APPROVE ROSELLI REALTY APPLICATION TERMS (Yes)