1001 Pine Street Apartment # 3

APPLICANT INFORMATION

Other Occupant Information (includes minors)

1st Occupant

2nd Occupant

3rd Occupant

4th Occupant

HOUSING REFERENCES

VEHICLE INFORMATION

EMPLOYMENT REFERENCES

EXPECTED HOUSEHOLD MONTHLY INCOME

Please Read Carefully and Sign This Application This application is NOT a rental agreement, contract, or lease! All applications are subject to approval. NOTICE: You may obtain information about the sex offender registry and persons registered with the registry by contract the Wisconsin Department of Corrections on the Internet at https://appsdoc.wi.gov/public/offenders or by phone at 877-234-0085 (make click to call). By signing below, I warrant and represent that I am at least 18 years of age and that all statements herein are true and correct, to the best of my knowledge. Also, I hereby consent to routine and periodic inquiry of references and credit agencies to provide applicable information concerning applicants character, address, creditworthiness, reliability, and income amount and hereby authorizes the release of this information to Emmerich & Associates, Inc. / Emmerich Properties.

OPTIONAL: Earnest Money Disclosure (ONLY if Earnest Money is Paid)

Receipt of earnest money deposit in the sum of $ TEXT BOX is hereby acknowledged; deports to be returned if application is not approved or no action is taken with TEXT BOX calendar days (if left blank, three days are assumed). If approved, this sum to be applied to security depost and/or first month’s rent. If applicant decides not to enter into a rental agreement after application approval, actual costs and damages incurred will be deducted from the deposit. Depost may be withheld as compensation for lost rent if landlord make reasonable efforts to mitigate damages in accordance with 704.29 Wisconsin Statutes. By signing below, i am certifying that i was given the opportunity to review a sample lease or rental agreement, and acknowledge that Earnest Money will be treated in accordance with WI SS 704.27 and ATCP 134.