EXCEL PROPERTY MANAGEMENT RENTAL APPLICATION Lofts at Noda Mills 3327 North Davidson Street, Charlotte, NC 28205 PH: (704) 372-7298 FAX: (980) 237~2633 theloftsatnodamills@epmsites.com MGR. INlTIALS @TIME RECEfVEO SOCIAL SECURITY VERrFTED What size apartment would you like to occupy? O 1 BR O 2 BR O 3BR What date do you anticipate moving?-~----...,,~ Email: ~-------- Best telephone number to reach you: ( ),~-,-.---~--------- LIST ALL HOUSEHOLD MEMBERS WHO WlLL LfYE IN 'l'he APARTMENT UPON MOVE-IN OR WITHIN THE NEXT TWELVE (12) MONTHS. INCLUDING ANY TEMPORARU,Y ADSE:NT (SUCH AS MfLITARYISTUDENT/SPOUSE) ME!vIBERS WHO WILL BE RETURNING TO TliE HOUSEHOLD. UNMARRIED ADULT CO~APPLICANTS MUST COMPLETE A SEPARATE APPLICATION. - Name all Househo ld Members- Relationship Is HH member Starting with Head of Household to Head of Social Security employed: First Middle Last Household Birth Date Number (Circle One) 1 2 3 4 5 6 First Middle Lll~! First Middle l,ut First Middle Last First Middle Lo.t First Middle Lost First Middle!,ast Do all household members live in the household ful time? DYES D NO Number of foster children? List names of all household members that are a student, plan on being a student in the next 12 months or was a student in the last 5 months: 0 o you expect any changes to household --~-------,-~----~~~--------- in the next 12 months? O YES O NO Will this apartment If NO, please explain: ~-~-~~~-------------,-- be your only place of residency? 0 YES D NO Have you ever been evicted or has a landlord If YES, pleas explain:.,...,,~~----- -- -- ever terminated your lease? D YES D NO Are you currently receiving rental assistance? DYES ONO If YES, which agency? ~-----~--~--- - - ----- ---- Page 1 of 6
EMPLOYMENT INFORMATION Applicant Employer: Phone: Address:------ ~------,-..-. City: State: Zip: Date Started: Position: -~-~-~~ Supervisor: Salary PER D Hour oweek D Month D Year D Other** **Please explain: ~-------~------------ Do you have a second job? 0 YES D NO If YES, Where? ~ Phone: Supervisor: ~ Salary~ PER OHour Oweek OMonth D Year D Other** ** Please explain: ~-- ---------- IF EMPLOYED BY CURRENT EMPLOYER LESS THAN SIX (6) MONTHS-PLEASE COMPLETE: Previous Employer:-- -~-----------~ Phone:- ----~-- Address: -... City: ~...- State: Zip:~-- Date Started: Date Ended: Position: ----~-S upervisor: Salary PER D Hour oweek D Month D Year D Other** **Please explain: SPOUS EMPLOYMENT (CO-APPLICANT MUST COMPLETE SEPARAT~ APPLICATION) Applicant Employer: Phone: Address: City: State: Zip: Date Started: Position:,,.. Supervisor: Salary ~PER D Hour oweek, D Month OYear D Other** **Please explain: ~---~---------------- Do you have a second job? 0 YES O NO If YES, Where? ~- --------- Phone; ~~-- Supervisor: ~-- ----- Salary PER QHour Oweek QMonth D Year O Other** *'I( Please explain: ~-~------~------ Page 2 of 6
LANDLORD HISTORY INFORMATION Current Address: ~. City: ~ State: Zip: Month & Year Moved In:! Amount of monthly rent or mortgage?-----~ Do you: 0 Rent O Own O Other (pleas explain) -,--.. Reason for leaving? Landlord or Mortgage Co.:~ Phone: City: ~--~ State:~~-- Zip: IF LESS THAN THREE YEARS AT CURRENT ADDRESS Previous Address: ~ City:~ State: Zip: Month & Year Moved In:.! Month & Year Moved out: ---------- / Amount of monthly rent or mortgage?...,... Reason for leaving? -- Did you: 0 Rent D Own D Other (pleas explain) ~ Landlord or Mortgage Co.:~.,...,, Phone: City:~.--~---------~ State: OTHER INFORMATION Zip:-~------ Are you or your spouse a veteran of the U.S. Military? D YOU D SPOUSE If YES, What branch?...,... Service Dates: ~-- Are you or any member of the household subjecto state lifetime sex offenderegistration? DYES D NO Have you ever been convicted of a crime? DYES D NO IF YES, When:---~---- Type of Charge(s): ----------------,.--------,--...--- Please list all states that anyone in household over 18 has ever lived/ or resided: HOUSEHOLD MEMBER STATE Page 3 of 6
Drivers license number/ State ID#: ~-- State Issued: HH Member: Drivers license number/ State ID#:~------ State Issued:~- HH Member: --- Drivers license number/ State ID#:------~ State Issued:--. HH Member: VEHICLE INFORMATION Ye~r: Make:--~- -- Model: Color License Plate# State ---- ---~-~- -~~----- -~--- Year: Make: Model: Color License Plate #------- State, Year: Make: Model: Color ---- ----~-- -------- ----- License Plate#---~-~-- State WARNING: Section 1001 of the Title 18, United States Code provides, ' 1 Whoever, in any matter within the jurisdiction of any department of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any tr'ick, scheme, or device a material fact, or makes false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than 10,000 or imprisoned not more than five years, or both." I/WE HEREBY MAKE APPLICATION FOR AN APARTMENT AND CERTIFY THAT THE INFORMATION GIVEN ON THIS APPLICATION IS TRUE AND CORRECT. I/ WE UNDERSTAND THAT THE MANAGING AGENT WILL VERIFY, IN WRITING, THROUGH A THIRD PARTY, THE INFORMATION PROVIDED ON THIS APPLICATION. I/WE UNDERSTAND FALSIFYING INFORMATION MAY LEAD TO DECLINATION OF APPLICATION. BY SIGNING BELOW, I CERTIFY I HAVE READ AND UNDERSTAND THE ABOVE: eoual HOU1HG OPPORTUN ITY Page 4 of 6
INCOME AND ASSET DISCLOSURE STATEMENT (INCLUDE ALL INCOME FOR ALL FAMILY MEMBERS OF THE HOUSEHOLD, INCLUDING CHILDREN UNDER THE AGE OF 18) (USE HOUSEHOLD MEMBER NUMBER FROM THE FIRST PAGE OF RENTAL APPLICATION) INCOME DISCLOSURE RECEIVING NOW OR HOUSE- AMOUNT DESCRIPTION OF INCOME ANTICIPATES HOLD RECEIVED COMMENTS RECEIVING MEMBER# MONTHLY Circle YES or NO Employment Income (including self- employment income) Alimony i3nd/or Child Support Disability 6r Workers Comp. Income from Employer or Settlement Social Security/ SSI or Social Security Disability Veterans Administration / Military Benefits TANF/ AFDC (Not Food Stamps) Income from Annuities / Insurance Policies Pension Income Income from Retirement Plans (IRA, 401 K, Keogh, etc.) Rental Income from Property.. Unemployment Benefits Financial aid / Grants / Scholarships Other Income (recurringifts, lottery winninqs, etc) *INCLUDE OVERTIME, TIPS, BONUSES, AND ANY OTHER TYPE OF COMPENSATION I/We certify this information is true and correct Page 5 of 6
ASSET DISCLOSURE (INCLUDE ALL ASSETS FOR ALL FAMILY MEMBERS OF THE HOUSEHOLD, INCLUDING CHILDREN UNDER THE AGE OF 18).. DESCRIPTION OF YOU MUST NAME & ADDRESS OF HOUSE- CURRENT ASSET CIRCLE BANK, AGENCY OR HOLD ONE (Yes or FINANCIAL MEMBER# CURRENT COMMENTS NO) INSTITUTION VALUE Cash Card or Benefit Card CARD#: (for benefits/wages, not associated with bank accounts listed) - - Sank Name: Checking Account ACCT,# Bank Name:.. Savings AccounU Money Market ACCT.# Cash Held in Safety deposit Box or at Horne Certificate(s) of Deposit (CD's) - Stocks/ Bonds /Treasuries/ Mutual Funds Individual Retirement Account (IRA, 401 K, Keogh) Real Estate Owned: Land / Addr~ss: House/Condo/ Mobile Horne Address: Rental Property Owned Personal Property held as Describe: an investment (Antiques, Starnps,Coins,Jewelry, etc) Life Ins. Co: Life Insurance Policy with a Cash Value Policy#: Trusts (Principal value available) - Any other asset held (Include jointly) I/We certify this information is true ~nd correct...page 6 of 6