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Form #1 : APPLICATION TO RENT

 

Required entries are indicated by blue icons or *

OWNER/AGENT TO COMPLETE

 


# of units available
(of the type and in the area) that will be available for rent in the near future by this owner.
# of applications previously accepted
and remaining under consideration for those units.
(If left blank, at least one unit is available and no previously accepted applications currently under consideration have been accepted.)

 Examined picture identification?

 

RENT, DEPOSIT & FEE DISCLOSURE

(Amounts listed below may be subject to change before the rental agreement is executed)
 
DEPOSITS MAY INCREASE IF APPLICANT IS UNABLE TO MEET ONE OR MORE OF OWNER/AGENTS SCREENING CRITERIA.

– Tenant is required to maintain minimum of $100,000 liability coverage and list Owner/Agent as Interested Party. If Tenant(s) combined household income falls at or below 50% of the median for the area, Renter’s Insurance may not be required. Owner/Agent is also responsible to maintain their own insurance policy and may not “self insure” if Renter’s Insurance is to be required. Owner/Agent must provide proof of property insurance to Tenant upon request.

Owner/Agent may charge the following:
  • Late payment of rent charge of
     
  • Smoke alarm and carbon monoxide alarm tampering fee of $250.
  • Dishonored check fee of $35 plus amount charged by bank.
  • Early termination of lease fee not to exceed 1-1/2 times the monthly rent, or actual damages at the option of Owner/Agent.
  • Owner/Agent may charge the following non-compliance fees after first giving a written warning notice of initial violation if noncompliance occurs within one year: $50 fee for 2nd violation, and $50 plus 5% of current rent for each subsequent violation.
    1. Failure to clean up animal waste, garbage, rubbish or other waste.
    2. Parking violation or other improper use of vehicle.
  • Owner/Agent may charge a fee for keeping on the premises an unauthorized pet capable of causing damage. Fee may be assessed for repeat violations that occur as early as 48 hours after the effective date of written warning notice, and for each subsequent violation within one year of issuance of written warning. Fee not to exceed $250 per violation.
  • Owner/Agent may charge a fee for smoking/vaping in a clearly designated non-smoking/vaping unit or area of the premises. Fee may be assessed for repeat violations that occur as early as 24 hours after the effective date of a written warning notice, and for each subsequent violation within one year of issuance of written warning. Fee not to exceed $250 per violation.

 

PERSONAL INFORMATION

 
(First Middle Last)
Telephone:
 (
)
-
Cellular Number:
 (
)
-

Telephone:
 (
)
-

Telephone:
 (
)
-

Telephone:
 (
)
-

Have you ever:
 
Been Evicted?

Filed Bankruptcy?

Been Sued by Landlord?

Been convicted, or plead guilty or no contest, to a crime?

If yes to any of these, please explain:
 

If your service or companion animal requires a reasonable accommodation please inquire with Owner/Agent.
 

 Animal 1

Ever injured anyone or damaged anything?

 Animal 2

Ever injured anyone or damaged anything?

 

OUTSTANDING DEBTS

 
Please list below all outstanding past due payment obligations and/or collections accounts.

 

BANK INFORMATION

 



 

EMPLOYMENT/INCOME

 
Telephone: 
 (
)
-

Telephone:
 (
)
-

Telephone:
 (
)
-

Telephone:
 (
)
-

 

REFERENCES

 
1. Relative:
Telephone:
 (
)
-
2. Emergency Contact:
Telephone:
 (
)
-
3. Personal Reference:
Telephone:
 (
)
-

 

PERSONAL PROPERTY

 
Automobile #1:

Automobile #2:

Other: (Vehicles/Boats)

Do you own the following:
 
Trampoline?

Water-filled furniture?

Fish Tank or Aquarium?

MEMBERS OF HOUSEHOLD

For purposes of identification only, please list names and either ages or dates of birth of other persons to occupy unit:

APPLICANT SCREENING CHARGE DISCLOSURES

 
  1. Owner/Agent may obtain a credit report, or a tenant screening report which generally consists of:
    • a) Credit history including credit report;
    • b) Public records, including but not limited to judgments, liens, evictions and status of collection accounts;
    • c) Current obligations and credit ratings; and/or
    • d) Criminal records or other information verification.
  2. Owner/Agent is requiring payment of an Applicant Screening Change, none of which is refundable unless the Owner/Agent does not screen the applicant. This application is valid for up to 30 days from date of receipt by Owner/Agent.
  3. Any charges imposed upon Owner/Agent by a Homeowner’s or Condominium Association for anyone who moves into or out of a unit within the association, may be passed through to the Tenant(s) for payment as allowed by law.
  4. If the mail receptacle associated with the dwelling unit is a locking type, Tenant(s) are solely responsible for the fees charged by the Postmaster for the re-keying of the box should a key not be provided by the Owner/Agent, or if the mail box has not been re-keyed between tenancies.

Incomplete applications will not be accepted. Inability to verify information may result in denial of application. Presentation of false information may result in denial of application or termination of tenancy if discovered within one year of submission of application.

I certify the above information is correct and complete and hereby authorize the Owner/Agent to make any inquiries the Owner/Agent feels necessary to evaluate my tenancy and credit standing (including, but not limited to credit reports). If Owner/Agent is requiring payment of an applicant screening charge, I acknowledge receiving a copy of and/or reading Owner/Agent’s Screening Guidelines. I understand that I have the right to dispute the accuracy of any information provided to the Owner/Agent by a screening service or credit reporting agency.

No marijuana, medical or otherwise, may be grown, stored or consumed on the premises without the prior written consent of Owner/Agent.

 

Please Note: Signature field must be filled in and signed after printing.

Applicant    Date 

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1462 Commercial St. NE, Salem, OR 97301
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