Step 1 of 5 20% POPLAR VILLAGE NORTH APARTMENT COMMUNITYTelephone: (541) 734-5455 Fax: (541)734-3760 Email: poplarvillagenorth@gmail.com Date Date Format: MM slash DD slash YYYY Applicant's Name M/I Date Date Format: MM slash DD slash YYYY Apartment #FOR OFFICE USE ONLY PLEASE DO NOT FILL IN Welcome and thank you for applying at Poplar Village North Apartments! The following is information and the application you will need to apply for residency at the Poplar Village North Apartments. If you have any additional questions, please contact us. Our hours are 9:00 AM – 5:00 PM Monday through Friday and 10:00 to 4:00 SaturdayPlease note that you will need to sign a 6 month lease Renters Insurance is required upon move in There is a $30.00 screening fee per applicant Poplar Village North Screens all applicants for Credit History, Eviction History, and Criminal History. To qualify for residency at Poplar Village North Apartments, all parties must adhere to: Employment: Permanently employed and on current job at least 6 months or Prior Employment of at least 1 year. Income: Gross Income must be equal to at least 3 month’s monthly rent amount. Proof of income must be attached to application. Residence History: Must have lived at current residence a minimum of 6 months or Prior Residence at least one year. Good Rental History: will be verified. Copy of Current Picture ID: Driver’s license, DMV ID card, Passport or Student ID (One is sufficient) Good Credit History: will be verified. Title VIII of the CIVIL RIGHTS ACT OF 1968: as amended makes discrimination based on race, color, religion, sex, national origin, handicap or familial illegal in connection with the rental of most housing. Equal Credit Opportunity Act: The Federal Equal Credit Opportunity Act prohibits creditors from discrimination against credit applications based on sex or marital status. Questionnaire: Please fill out the following short questionnaire. Please note that we will not process your application unless all the questions are answered, and sufficient income documentation is provided. The two page application is attached to this cover sheet. Thank you! 1. When do you need to move in?2. How many residents will live in the apartment?What is your current rent?3. Do you have any pets?If yes, what type?How many?4. Do you smoke?5. Do you have a waterbed?An aquarium?6. How did you hear about Poplar Village North? POPLAR VILLAGE NORTH RENTAL APPLICATION APPLICANT’S FULL NAMEDATE OF BIRTH Date Format: MM slash DD slash YYYY DRIVER’S LICENSE #SOCIAL SECURITY #PHONE #WORK/CELL PHONE #E-MAIL ADDRESSAPPLICANT RESIDENTIAL INFORMATION:Please provide at least 2 years of residential historyPRESENT ADDRESSOWNER/AGENT NAMEPHONE NODATE IN Date Format: MM slash DD slash YYYY DATE OUT Date Format: MM slash DD slash YYYY REASON FOR MOVINGCURRENT MONTHLY RENT PREVIOUS ADDRESSOWNER/AGENT NAMEPHONE NODATE IN Date Format: MM slash DD slash YYYY DATE OUT Date Format: MM slash DD slash YYYY REASON FOR MOVINGPREVIOUS MONTHLY RENT PREVIOUS ADDRESSOWNER/AGENT NAMEPHONE NODATE IN Date Format: MM slash DD slash YYYY DATE OUT Date Format: MM slash DD slash YYYY REASON FOR MOVINGPREVIOUS MONTHLY RENT APPLICANT’S PERSONAL REFERENCE (LIST 2 UNRELATED)NAMEPHONEADDRESSNAMEPHONEADDRESS POPLAR VILLAGE NORTH RENTAL APPLICATION APPLICANT RESIDENTIAL INFORMATION:Please provide at least 2 years of residential historyCURRENT EMPLOYERJOB TITLEEMPLOYER’S ADDRESSEMPLOYMENT DATES Date Format: MM slash DD slash YYYY GROSS MONTHLY INCOMESUPERVISORPHONEFAXIF LESS THAN 2 YEARS: PREVIOUS EMPLOYERJOB TITLEEMPLOYER’S ADDRESSEMPLOYMENT DATES Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY GROSS MONTHLY INCOMESUPERVISORPHONEFAX PREVIOUS EMPLOYERJOB TITLEEMPLOYER’S ADDRESSEMPLOYMENT DATES Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY GROSS MONTHLY INCOMESUPERVISORPHONEFAX PREVIOUS EMPLOYERJOB TITLEEMPLOYER’S ADDRESSEMPLOYMENT DATES Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY GROSS MONTHLY INCOMESUPERVISORPHONEFAX OTHER INCOME AMOUNTSOURCEOTHER INCOME AMOUNTSOURCE POPLAR VILLAGE NORTH RENTAL APPLICATION ADDITIONAL OCCUPANTS (INCLUDING CO-APPLICANT) (LIST 2 UNRELATED)NAMERELATIONSHIPDATE OF BIRTH Date Format: MM slash DD slash YYYY NAMERELATIONSHIPDATE OF BIRTH Date Format: MM slash DD slash YYYY NAMERELATIONSHIPDATE OF BIRTH Date Format: MM slash DD slash YYYY VEHICLESMAKE, MODEL, YEARLICENSE NUMBER & STATEMAKE, MODEL, YEARLICENSE NUMBER & STATE APPLICANT EMERGENCY CONTACTSNAME, ADDRESS & PHONERELATIONSHIP TO TENANTNAME, ADDRESS & PHONERELATIONSHIP TO TENANT Please continue to page 5 to complete the application. POPLAR VILLAGE NORTH RENTAL APPLICATION HAVE YOU OR OTHER OCCUPANTS EVER BEEN CONVICTED OF ANY CRIME?NOYESNAME:LIST CRIMES AND DATES OF CONVICTIONS: HAVE YOU OR YOUR CO-APPLICANT EVER FILED ANY TYPE OF BANKRUPTCY PROCEEDINGS?NOYESNAME:WHAT COUNTRY AND STATE?PLEASE EXPLAIN HAVE YOU, YOUR CO-APPLICANT, OR OTHER OCCUPANTS EVER RECEIVE WRITTEN NOTICE FROM ANY LANDLORD THAT YOUR TENANCY WILL BE TERMINATED FOR ANY REASON?NOYESNAME:PLEASE EXPLAIN HAVE YOU, YOUR CO-APPLICANT OR OTHER OCCUPANTS EVER BEEN EVICTED OR HAD EVICTION PROCEEDINGS COMMENCED AGAINST YOU IN ANY COURT IN THIS STATE OR ANY OTHER?NOYESNAME:PLEASE EXPLAIN APPLICANT SCREENING CHARGE DISCLOSURE(S) OWNER/AGENT MAY OBTAIN A TENANT SCREENING AND/OR CREDIT REPORT WHICH SCREENS FOR CREDIT HISTORY, CRIMINAL HISTORY AND EVICTION HISTORY. I AUTHORIZE THE LANDLORD TO MAKE ANY INQUIRIES AND RECEIVE ACCESS TO ANY INFORMATION FROM ANY CREDIT BUREAU, CREDIT REPORTING AGENCY, EMPLOYER OR REFERENCE LISTED IN THIS APPLICATION, TO ENABLE THE LANDLORD TO EVALUATE MY QUALIFICATIONS AS A PROSPECTIVE TENANT. I HEREBY CERTIFY AND VERIFY THAT THE FOREGOING RENTAL APPLICATION FORM HAS BEEN COMPLETED AND FILLED OUT TRUTHFULLY AND ACCURATELY. I UNDERSTAND THAT THE LANDLORD WILL BE RELYING UPON MY ANSWERS AND STATEMENTS IN THE APPLICATION IN CONSIDERING ME AS A PROSPECTIVE TENANT. SignatureDate Date Format: MM slash DD slash YYYY