McScott Investments

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1. General Information about yourself

Name and Address

Email Address

Home Phone Work Phone

Drivers license number State Expiration
Birthdate Birthplace
Social Security #

2. List all household members who will live in the Rented Premises

Name Age
Name Age
Name Age
Name Age
Name Age

3. Applicant's Rental History

Length of Time at Current Address
Name of Present Landlord Telephone

Previous Address
Length of Time
Name of Landlord Telephone

4. Applicant's Employment

Occupation How Long?
Employer Name/Address
Employer Contact Name Phone
Current Salary
Educational Background

5. Spouse's Employment

Occupation How Long?
Employer Name/Address
Employer Contact Name Phone
Current Salary
Educational Background

6. Applicant's Vehicles

Make/Model Year Color State Plate #
Make/Model Year Color State Plate #
Make/Model Year Color State Plate #

7. Miscellaneous

Have you ever been evicted? Yes . . . No
Have you ever failed to pay timely rent? Yes . . . No
Have you ever filed for bankruptcy? Yes . . . No
Have you ever been arrested? Yes . . . No
Please explain below if you checked "yes" for any items

DISCLOSURE/AGREEMENT/CONSENT

I/We authorize you to conduct an employment/credit check concerning my/our application and to verify all references. I/We declare that all information listed on this application is true and accurate.

Applicant's signature: Date: