TILL PROPERTY, INC.

P O Box 790

Anahuac, TX 77514

490.267.6980

RENTAL APPLICATION

Applicant’s Full Name:___________________________  Phone Number:___________

Mailing Address:________________________________________________________

Physical Address:_______________________________________________________

DL State/Number:_________________ SS#:________________ Date of Birth:___

Marital Status:    ___Single    ___Married    ___Widowed    ___ Separated

Race:_________________  How Did you hear about us?_________________

Why are you moving?_____________________________________________

Have you given your present landlord notice of your intent to relocate?______

YOUR SPOUSE OR CO-TENANT

Full Name: _____________________________________  Phone :__________

Mailing Address:__________________________________________________

Physical Address:_________________________________________________

DL State/Number:_____________ SS#:___________ Date of Birth:_________

Marital Status:    ___Single    ___Married    ___Widowed    ___ Separated

Race:_________________Why are you moving?______________________ 

RENTAL HISTORY

Current Landlord:______________________________  Phone:____________

Addresss:______________________________________________________________

How long did you live there? _____________     Monthly Rent:_____________

Previous Landlord:__________________________  Phone Number:_________

Addresss:______________________________________________________________

How long did you live there? ____________     Monthly rent:______________

OTHER OCCUPANTS

Name:_____________________________  Age:____  Date of Birth:________

SS Number:____________ DL Number/State:_____________  Relationship:_________

Name:__________________________Age:______  Date of Birth:________ SS Number:____________ DL Number/State:_____________  Relationship:_________

Name:________________________  Age:______  Date of Birth:___________

SS Number:____________ DL Number/State:_____________  Relationship:_________

VEHICLES

Make & Model:__________________________  Year:__________________

Color:__________________  License Plate #:_________________

Make & Model:__________________________  Year:__________________

Color:__________________  License Plate #:_________________

FAMILY REFERENCES

Name:_________________________________  Phone: __________________

Address:______________________________________________________________

Name:_________________________________  Phone: __________________

Address:________________________________________________________

Name:_________________________________  Phone: __________________

Address:______________________________________________________________

Name:_________________________________  Phone: __________________

Address:______________________________________________________________

NON-RELATED REFERENCES

Name:_____________________________  Phone:______________________ Address:______________________________________________________________

Name:_____________________________  Phone: ______________________

Address:______________________________________________________________

EMERGENCY CONTACT

Name:__________________________  Relationship:____________________

Address:_______________________________________________________________

Day Phone Number:______________Evening Phone Number:______________

Do you authorize the above named person to take possession of your property in case of serious illness, death or disappearance? ____YES  ____ NO/If no please list who to release :________________________________________

Are we authorized to release any monies due you to the above named persons?______

If no please list who to release it to:_________________________________

GENERAL INFORMATION

Does anyone in your household have a criminal record besides traffic fines?___

Please describe:________________________________________________________

Does anyone in your household use or sale drugs, or been arrested for drugs?_

Has anyone in your household been convicted of a felony or received deferred adjudication?  If so explain:________________________________________

Has anyone in your household been arrested or convicted as a sex offender?  If so explain:_____________________________________________________

Has anyone in your household previously rented from Till Property, Inc, PLB or Chaparral?___

If so when & reason for leaving:____________________________________

Has anyone in your household ever done any of the following?  If so when & where:

          Broken a lease agreement?_________________________________

          Been evicted?_____________________________________________

Been sued for damages or non-payment for previous residency? _____ 

CREDIT/BANKING REFERENCES

Company:_______________  Phone Number:__________ Acct #___________

Address:_______________________________________________________________

Company:______________  Phone Number:__________ Acct #___________

Address:_______________________________________________________________

Bank:__________________  Phone Number:__________ Acct #___________

Address:_______________________________________________________________

INCOME INFORMATION

Applicant’s Employer:___________________  Phone Number:_____________

Address:_____________________________  Monthly Net Wages:_________

Spouse/Co-Tenant’s Employer:____________  Phone Number:_____________

Address:_____________________________ Monthly Net Wages:_________

Social Security Income:______________Child Support/Alimony:____________

Other Income:__________________________________________________________

CERTIFICATION & SIGNATURES

I/WE certify that all statements made on this application are true and correct.  I/WE authorize the owner or its representative to contact any person listed on the application to verify any information contained herein.  I/WE further understand that if any information found to be false or incorrect that my/our application may be rejected.  I/WE also certify that the unit being applied for will be my/our permanent residence and will not hold a separate unit in a different location.  I/WE further understand that there is a $25.00 application fee payable at the time application is made.  I/WE also understand that by signing this application I/WE give my/our permission to the owner or its representatives to run a criminal background check and/or credit report.

Applicants signature:_____________________________  Date:____________

Spouse/Co-Applicant Signature:____________________  Date:____________

Co/Applicant Signature:___________________________  Date:____________

Co-Applicant Signature:___________________________  Date:____________