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Pomerance Properties, LP
Rental Application & Information Release Form
1st Applicant's
Name *
E-mail*
Maiden Name
Social Security No. *
Date of Birth *
Drivers Licence No.* State*
 
2nd Applicant's
Name
Maiden Name
Social Security No.
Date of Birth
Drivers Licence No. State
PRESENT RESIDENCE INFORMATION
Present Address *
City * State* Zip*
Telephone*
Is this your telephone?*
How long at this address?*
Landlord's name *
Landlord's address *
Landlord's telephone *
What month & year did you move in? *
   
What name is used by gas & electric company for billing? *
What name is used by the phone company for billing? *
What name is used for water company for billing? *
Where do you pay your rent? *(address/city/state/zip)
Why are you moving? *
How much is your current rent? *
Previous Address *
City * State* Zip*
Previous Landlord *
Previous Landlord's Phone *
EMPLOYMENT REFERENCES
1st Applicant's Employer *
Employer's Address *
Employer's Phone No.*
Supervisor's Name
Department*
Phone No. *
Length of time employed *
Position*
Monthly income *

Any additional
income *

2nd Applicant's Employer
Employer's Address
Employer's Phone No.
Supervisor's Name
Department
Phone No.
Length of time employed
Position
Monthly income
Any additional income
BANKING REFERENCES
Bank Name (Checking/Acct.)*
Account No. *
Bank Name (Checking/Acct.)
Account No.
Bank Name (Saving/Acct.)
Account No.
NAMES OF PEOPLE WHO WILL BE LIVING AT THIS ADDRESS
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
PERSONAL REFERENCES (NOT RELATED)
Name *
Address *
Phone *
Name *
Address *
Phone *
Name *
Address *
Phone *
Mother's name *
Mother's address *
Father's name *
Father's address *
IN CASE OF EMERGENCY CONTACT
Name *
Phone *
Address *
Relationship *
Name
Phone
Address
Relationship
VEHICLES OWNED
Auto Lic. Plate No. State
Make Year
Auto Lic. Plate No. State
Make Year
Auto Lic. Plate No. State
Make Year
       
Have you ever been convicted of a: *
Felony Misdemeanor None
If yes, explain

Have you ever gone through bankruptcy, been evicted, had any judgements, creditors or other legal proceeding against you? *

Yes No
If yes, explain
Property address of residence you are applying to rent *
   
A non-refundable credit checking fee of $25.00 for 1st applicant and $15 for each additional is due at the time the rental application is processed.
 
I/we hereby authorize POMERANCE PROPERTIES, LP and/or any Credit Information Services to obtain information concerning my past credit, and/or tenant-landlord history now or anytime in the future. I hereby authorize any of the following sources, including but not limited to landlords, public or privately owned utilities, current or past creditors, governmental housing agencies, and/or other credit reporting agencies to release any information to POMERANCE PROPERTIES, LP or any Credit Information Service concerning my/our past credit and/or tenant-landlord history. I hereby release any of the above sources, their officers, agents, or employees from any liability for damages of whatsoever kind or nature whether caused by negligence or otherwise which may at any time result to me/us by reason of compliance with the above mentioned inquiry which may include the answering of specific questions and the giving of any information concerning my/our past records.
 
I HAVE READ THE ABOVE AND I AM IN COMPLETE AGREEMENT WITH IT.
1st applicant name *
2nd applicant name
Date *
 

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