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                                                                                                                        Last:_________________

Rental Application & Credit Report Order Form          Unit           _________________

NCS Credit Bureau, Corp. , P.O. Box 185, Addison, IL 60101         800/462-4627        Rent          _________________                                                                                                      Fax: 800/320-1615        Term          _________________

From:  At Home Property Management Company, LLC                                                      QBP IV                   _____

          847/332-2525; Fax 847/332-2596         415/435-2525; Fax 415/435-2564 QBP Mem Tx        _____

         1026 Garnett Place , #2R                  1870 West Vistazo St.                   QBP Credit Memo        _____     

         Evanston, IL 60201-1339                 Tiburon,  CA  94920-1823         FMP Data        _____

 

Method of Payment:  Robert P. Taylor’s Visa Acct# On File                                     NCS Member #:  95849

Fax Visa Receipt to:  847/332-2596 (No Cover Page Necessary)

Fax Credit Reports to:  ____ 847/332-2596;  ____ 415/435-2564; or to ____________________

 

This section to be completed ONLY PLEASE by Property Manager of At Home Property Management Company.

Date Application Accepted (with Application Fee): __/___/____   Time:  _______          Lease:  ___/___/___  to ___/___/___

Apartment Address: _________________ Monthly Apt. Rent:  $_______  Apt. Security Deposit: $______

Resident’s Name(s): ___________________Parking Rent:             $________   Parking Sec. Dep.: $______

Bedroom Designation: _____________                                       

Parking Lease (Y/N, vehicle type): ____________________ Parking or Garage #: _______

 

Payment History:                                                                    Total Owed:                    App Fee                       ________

Pmt#1: $______  Date: ________ Ck# _______ For:                                 Security Deposit Apt          ________

Pmt#2: $______  Date: ________  Ck# _______ For:                                       1st Month Rent Apt          ________

Pmt#3: $______  Date: ________  Ck# _______ For:                                Security Deposit Pkg          _______

Pmt#3: $______  Date: ________  Ck# ______                                                  1st Month Rent Pkg          ________                                                                                                     TOTAL DUE                              $_______

 

__ Single Report          __ Joint Report  ( Married, same last name )             __Court Eviction Search          __ Criminal Check

__ Complete Package/single     __ Complete Package/Joint (Complete Package includes credit report & eviction report)

__ Employment Verification   __ Residency Verification

 

 

Applicant’s Name: ___________________________  Applicant's SS# _____-____-_____  Birth Date __________  

  Present Address: __________________________________ City _______________ State ____   Zip__________

  Work, Home, Cell, Fax Phone Numbers: ___________________________________________________________

  Email Address(es):  _____________________________________________

Spouse's/Coapplicant’s Name: ________________________ Applicant's SS# _____-____-_____ Birth Date ______  

  Present Address: __________________________________ City _______________ State ____   Zip__________

  Work, Home, Cell, Fax Phone Numbers: ___________________________________________________________

  Email Address(es):  _____________________________________________

Present Landlord's Name __________________________________  Phone (        )_________________________

How Long at Above Address?_______________________

Previous Landlord's Name __________________________________  Phone (        )_________________________

How Long at Above Address?_______________________

 

Employer(s) ___________________________________________________   Phone (       )__________________

Position________________________________________ Annual Income:___________Starting Date__________

 

Spouse's/Coapplicant’s Employer: ___________________________________ Phone (       )__________________

Position________________________________________ Annual Income_________Starting Date_____________

 

Emergency Point of Contact: __________________ Relationship: ________________  Phone (       )______________

               

I/We hereby authorize the above mentioned person to use any consumer reporting agency, credit bureau or other investigative agencies employed by such to investigate the references herein listed or statements or other data obtained from me or from any other person pertaining to my employment history, prior tenancies, character, general reputation, personal characteristics and mode of living, to obtain a consumer report and such other credit information which may result thereby, and to disclose and furnish such information to the owner/agent listed above in support of this application.  I /We have been advised that I/We have the right, under Section 606B of the Fair Credit Reporting Act, to make a written request, within reasonable time, for a complete and accurate disclosure of the nature and scope of any investigation.   I/We  will convey the  importance  of  confidentiality to  the recipient of the report and I/We release NCS Credit Bureau Corp. from any liability arising from the recipient's misuse of the report.

 

Applicant's Signature ____________________ Date: _______      Spouse's/Coapplicant’s Signature __________________ Date: ______

 

                                                                                                                                                                                                                          Revised: 7/26/03

 

 

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