Rental Application

Full Home Cell

Name____________________________ Phone______________ Phone______________

Date of Social Security Driver License state ( )

Birth____________________ No.___________________ No.__________________

Full Home Cell

Name____________________________ Phone______________ Phone______________

Date of Social Security Driver License state ( )

Birth____________________ No.___________________ No.__________________

Present Address_________________________________________________________

How long at this address?______ Rent $______ Reason for moving___________

Owner/Manager_______________________________________Phone______________

Previous Address________________________________________________________
How long at this address?______ Rent $______ Reason for moving___________

Owner/Manager_______________________________________ Phone______________

Name of every person to live with you, even if only temporarily:

 (864) 237-5611 Email: dai@daiproperties.com

_______________________________________________________________________

# of Smokers ______ Trampoline? ______Waterbed?______RV?___ Boat?___

# Dogs_______ Breed_______ # of Cats ______ #Birds ___ #Fish ____ Other___

Present
Employer____________________________________________ Phone______________
How long with this
employer?__________ Supervisor______________________ Phone______________
Previous
Employer____________________________________________ Phone______________
How long with this
employer?__________ Supervisor______________________ Phone______________

Current Gross Income Per Month (before deductions) $____________________

List sources of income (other than present employment listed above)
_______________________________________________________________________

Saving: Bank_______________ Checking: Bank_______________

 Wenjing Dai, 109 Goldfinch Av, Greensboro, NC 27409

Major Credit Monthly Child Monthly

Cards_______________ Pmt._________ Support_______________ Pmt._________

Car Loan Monthly Home Loan Monthly

with:_______________Pmt._________ with:_______________ Pmt._________

HAVE YOU ever filed bankruptcy?_________ ever been evicted?_________ or ever

been convicted of a felony?______ Explain any "yes" answers on back.
Vehicle(s)
Make(s)____________ Model(s)________ Year(s)________ License(s)_________

Personal
Reference________________ Address_____________________ Phone____________

Contact in
Emergency________________ Address_____________________ Phone____________

We sometimes receive multiple well-qualified applications. If that is the

case, would you be interested in offering extra incentives to get the lease?
Yes No
If Yes, I will consider Pay extra rent, up to $____/month; Extra
deposit, $_______ extra work, my skills: ____________________

I declare that the statements above are true and correct. I authorize
verification of my references and credit as they relate to my tenancy AND to
future rent collections.

Date________________ Signed_____________________________________________

Verified: SSN____DL/ID____CurTen____Prev____Credit___Inc___Refs___By____