APPLICATION FOR RENTAL

Mid-Valley Management, Inc., 325 Superior Street SE, Salem, OR 97302, 503-585-5605

APPLICATION WILL NOT BE PROCESSED WITHOUT $35.00 APPLICATION FEE

                                                

DATE  ______________

RENTAL ADDRESS _______________________________________________________________________

Application must be complete. Failure to complete or false information will lead to immediate denial. You must have two (2) rental references, one at least one year in duration.  Six (6) months on the job. Income requirement is three (3) times the monthly rent. A background and Credit check will be done.

 

PERSONAL INFORMATION

Name___________________________________________________________________________________

D.O.B.___________________________________SS#_______________________________

Dr Lic#________________State_____  E-Mail                                                                                                   .                                  

CURRENT RESIDENCE

Address __________________________________________________________________________________________________

Phone Day_____________________________________Night _____________________________________

Own or rent?_______________________________Monthly Payment________________________________

Date of Occupancy: From______________________To__________________________________________

Name of Landlord:_________________________________________________________________________

Address:_______________________________________Phone_____________________________________

 
PREVIOUS RESIDENCE HISTORY

Address:_________________________________________________________________________________

________________________________________________________________________________________

Own or rent?_________________________________________________Payment_____________________

Length of occupancy. From_______________________To________________________________________

Name of Landlord:_________________________________________________________________________

Address:________________________________________Phone____________________________________

 

INCOME DESCRIPTION

Employer________________________________Complete Address__________________________________

Phone #_____________________Net Income____________________________________________________

Income (Grose/Net) ________________________________________________________________________

Other sources of income:_____________________________________________________________________

Vehicle Make_____________________Year___________Model___________________________________.

Names & D.O.B. for all persons to occupy unit.

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Do you have pets?______________Type______________________Do you use a waterbed?_______________

Do you intend to use a piano?___________________Do you have an aquarium?_________________________

Evictions?________________________Affiliated with gangs or convictions?___________________________

Why are you vacating present place of residence?__________________________________________________

 

APPLICANT CERTIFICATION OR ACCURACY/SIGNATURES

Applicant hereby certify that this information is true and correct.

 

Signature of Applicant