Application for Residency

Please provide all of the information requested below. Incomplete information can delay the processing of your application. There is a $75.00 processing fee for applications please make check payable to Imperial Estates Realty, Inc or contact Imperial Estates Realty, Inc at (727) 797-1000 to make payment via phone. You may also download the printable application and fax it to (727) 797 1001

Applicant

Please tell us a little about yourself

First name * Middle name Last name * Date of Birth * Married Single * Social security * Driver's License * Present Phone No. * 9:00 to 5:00 Contact Phone * Ext.

Have you or any occupants ever been arrested for, convicted of, put on probation for, had adjudication withheld or deferred for a felony offense No Yes *

Please expalain *

Have you ever had an eviction filed against you? No Yes *

Please explain

Do you have any pets? No Yes *

How many pets do you have? 1 2 3 4

Pet #1

Pet breed * Pet weight * Pet age *

Pet #2

Pet breed * Pet weight * Pet age *

Pet #3

Pet breed * Pet weight * Pet age *

Pet #4

Pet breed * Pet weight * Pet age *

Current Residence

Street address *

City *

State *

Zip *

Currently Own Rent *

Rent/Mortgage payment amount *

Since *

Current Landlord or Mortgagee *

Street address *

City *

State *

Zip *

Phone *

Previous Residence

Street address *

City *

State *

Zip *

Previously Own Rent *

Rent/Mortgage payment amount *

Since *

Present Employer

Name * Business address * City * State * Phone * Position * Supervisor name * Monthly income * Start date *

Previous Employer

Name * Business address * City * State * Phone * Position * Supervisor name * Monthly income * Start date * End date

Emergency contact

Name *

Address *

City *

State *

Phone *

How many automobiles do you have? 0 1 2 3 4 *

Auto #1

Year Make * Model * Color * Tag # *

Auto #2

Year Make * Model * Color * Tag # *

Auto #3

Year Make * Model * Color * Tag # *

Auto #4

Year Make * Model * Color * Tag # *

How many children will be living with you in your new home? 0 1 2 3 4 5 6 *

Child #1

Name * Age *

Child #2

Name * Age *

Child #3

Name *

Age *

Child #4

Name *

Age *

Child #5

Name * Age *

Child #6

Name * Age *

Banking Reference

Name *

Accounts Savings Checking Both *

Personal References

(2 family & 2 friends)

Personal Reference #1 *

Personal Reference #2 *

Personal Reference #3 *

Personal Reference #4 *

Applicant authorizes Imperial Estates Realty, Inc & the landlord to contact past and present landlords, employers, creditors, credit bureaus, neighbors and any other sources deemed necessary to investigate applicant. All Information is true, accurate and complete to the best of applicant’s knowledge. Imperial Estates Realty, Inc & the Landlord reserve the right to disqualify tenant if information is not as represented or misrepresented.

This application is submitted with the expressed understanding that it is not binding on either of the parties and no agreement shall exist between the Landlord and Tenant until both parties have executed a definitive lease.

ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED PRESENTATION OF THIS FORM AT ANY TIME.

I HAVE READ AND AGREE TO THE PROVISIONS AS STATED *

Signature *

Date *

Thank you for your submission, we will be in contact soon.