303 West 23rd Street
Office
Hope, AR 71801
870-722-2292
Rental Application
Today’s Date ___________________
Desired Apartment Location: _____ Downstairs _____ Upstairs ______ 1st available
Desired Move In Date: _______________________ Length of lease desired? 12 month 24 month
Personal Information
Name of Applicant ____________________________________ Date of Birth _______________________
Social Security # _____________________________ DL # / State ________________________________
Home Phone # _______________________________ Cell Phone # _______________________________
Present Address ________________________________________________________________________
City _________________________________ State ________________ Zip _______________________
How long have you lived at present address? ____________________ May we contact landlord? _______
Name of Present Landlord __________________________________ Phone # ______________________
Prior Address __________________________________________________________________________
City _________________________________ State ________________ Zip _______________________
How long did you live at prior address? _______________________________________________________
Name of Prior Landlord _____________________________________ Phone # ______________________
How many will be living in this unit? Adults ________ Children (ages) ____________________________
NO PETS ALLOWED
Employer ________________________________________ Occupation ___________________________
Current Salary _______________________ How long employed? ________________________________
Supervisor Name_______________________________________ Phone # _________________________
Spouse or Co-Applicant Information
Name _________________________________________ Date of Birth ___________________________
Social Security # ___________________________ Driver’s License # / State________________________
Employer ________________________________________ Occupation ___________________________
Current Salary _______________________ How long employed? ________________________________
Contact Person __________________________________ Phone # ______________________________
Bank Information
Checking acct. _____ Yes _____ No Bank Name ___________________________________________
Personal References
Name _____________________________ Relationship _______________ Phone # ________________
Name _____________________________ Relationship _______________ Phone # ________________
Name _____________________________ Relationship _______________ Phone# ________________
Other Information
HAVE YOU EVER
Filed for Bankruptcy? _____ Yes _____ No If yes, when? ___________________________________
Been served an eviction notice or asked to vacate a property you were renting? _____ Yes _____ No
Willfully or intentionally refused to pay rent when due? _____ Yes _____ No
If yes, when? ___________________________ Been sued by any landlord? _____ Yes _____ No
Been convicted of a felony? _____ Yes _____ No If yes, when? ______________________________
Explain ______________________________________________________________________________
How were you referred to us? ____ Newspaper (name) _______________________________________
Tenant (name) __________________________________________________________________________ Other __________________________________________________________________________
Consent to Obtain Credit / Employment Information
I/We authorize Canyon Creek Apartments to investigate my/our credit qualifications and hereby release, in
any manner, all of the information obtained by you. I/We further release all persons, agencies, or firms
from any liabilities resulting from providing such information.
I/We declare under penalty of perjury that the information listed in this application is true and correct.
Executed on this _____ day of __________________, 20____ in the city of Hope, state of Arkansas.
The undersigned authorizes landlord, leasing agent, and representatives of owner/landlord to contact the undersigned’s current or previous landlord, and current employer, and further, by a copy of this Application, authorizes any said landlord or employer to release pertinent residential and employment history information to be used in evaluating this lease application. I further authorize owner/landlord, leasing agent or its representatives to apply for or obtain an investigation or credit report in connection with this application. I understand that said investigation or credit report may contain information obtained from various state governmental and private entities relative to the undersigned’s number of children, employment, occupation, general health, financial, and criminal history information.
_______________________________________ _____________________________________
Applicant’s Signature Date Co-Applicant’s Signature Date
