R.O. LLC Rental Credit Application Information Verification Agreement PLEASE COMPLETE ALL INFORMATION Property Address Applying For:__________________________________________ This agreement made and concluded this____day of________________, 20_____ by and between R.O. LLC, hereafter" Owner" and __________________________________________________________ hereafter "Applicant." For and consideration of the promises and covenants contained herein, the parties hereby agree as follows: 1. The Applicant shall pay to the Owner a nonrefundable fee upon the execution of this agreement in the amount of fifty dollars ($50.00) for single individual or seventy dollars ($70.00) per couple to cover the administration costs, expenses and time of the Owner to verify the information submitted by the Applicant to determine whether or not the Owner will or will not rent or sell premises owned or controlled by the Owner to the Applicant. Please send completed application and check or money order to PO Box 21, Lodi, New York 14860-0021 for immediate processing. Phone 1-315-406-1999 Fax 1-866-311-6635 2. Applicant authorizes the Owner, his employees, agents or representatives to make any and all inquiries necessary to verify the information provided herein, including but not limited to direct contact with Applicant's employer, past employers, landlord, prior landlords, credit, credit bureau, neighbors, police agencies and any and all other sources of information which the owner may deem necessary and appropriate within his sole discretion. 3. The applicant represents to the Owner that all the information provided for herein is true, accurate and complete to the best of the Applicants knowledge and further, agrees that if any such information is not as represented, then the Applicant may, at the Owner's sole discretion, be disqualified as a tenant. 4.The Applicant provides the following information to the owner APPLICANT SSN __________________________________________________DOB____________________ DRIVERS LICENSE NUMBER____________________________________________________ ISSUING STATE___________________________________EXPIRATION DATE___________ CURRENNT PHONE(_________)____________________ IS THIS YOUR PHONE? YES NO IF NOT, WHOSE PHONE IS IT?__________________________________________________ CURRENT ADDRESS:__________________________________________________________ CITY_________________________________________STATE_______ZIP____________ NAME OF OWN ER OR MANAGER_______________________________________________ PHONE NUMBER (__________)______________________________ ADDRESS RENT OR PAYMENTS ARE SENT______________________________________ WHEN DID YOU MOVE IN?______________________________ CURRENT RENT OR PAYMENTS $__________ HAVE YOU GIVEN NOTICE? YES OR NO MAY WE CALL YOUR LANDLORD/MANAGER? YES OR NO DO YOU PAY YOUR RENT ON TIME? YES OR NO HAVE YOU BEEN ASKE:D TO LEAVE? YES OR NO WHY ARE YOU MOVING?______________________________________________________ PREVIOUS ADDRESS:_________________________________________________________ CITY________________________________________________________________________ NAME OF OWNER OR MANAGER________________________________________________ PHONE NUMBER (__________)______________________________ ADDRESS RENT WAS SENT____________________________________________________ WHAT RENT DID YOU PAY? $: ____________________ WHEN DID YOU MOVE IN?____________________ WHEN AND WHY DID YOU MOVE OUT ____________________________ DID YOU GIVE NOTICE YES OR NO WHERE YOU ASKED TO LEAVE YES OR NO DID YOU PAY RENT ON TIME? YES OR NO CURRENT EMPLOYER_________________________________________________________ PHONE NUMBER (__________)____________________ OCCUPATION____________________________________________________________ HIRE DATE____________________________ SUPERVISOR_________________________________________________________________ SALARY_____________________________________________________________________ FULL TIME? YES OR NO IF PART TIME, HOW MANY HOURS?____________________ OTHER CURRENT EMPLOYMENT OR SOURCES OF INCOME SOURCE_____________________________________________________________________ PHONE NUMBER (__________)______________________________ REASON (SSI, ETC.)__________________________________________________________ IF EMPLOYMENT, HIRE: DATE______________________________ OCCUPATION________________________________________________________________ SUPERVISOR_________________________________________________________________ AMOUNT RECEIVED$_________________________ FULL TIME? YES OR NO IF PART TIME HOW MANY HOURS?____________________ PERSONAL REFERENICES NAME_______________________________________________________________________ ADDRESS:___________________________________________________________________ PHONE (_____)______________________________ RELATIONSHIP_______________________________________________________________ NAME_______________________________________________________________________ ADDRESS:___________________________________________________________________ PHONE (_____)______________________________ RELATIONSHIP_______________________________________________________________ Emergency Number__________________________________________________________ NUMBER TO OCCUPY__________________________________________________ LIST BELOW THE NAMES AN D RELATIONSHIPS OF ALL PERSONS OCCUPY PREMISES NAME_______________________________________________________________________ RELATIONSHIP_______________________________________________________________ NAME_______________________________________________________________________ RELATIONSHIP_______________________________________________________________ NAME_______________________________________________________________________ RELATIONSHIP_______________________________________________________________ NAME_______________________________________________________________________ RELATIONSHIP_______________________________________________________________ Do you have any pets Yes NO Give details of pet type and size __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ OWNER IS NOT L/ABLE TO THE APPLICANT, HIS HEIRS, EXECUTORS, ADMINISTRATORS, OR ASSIGNS FOR ANY DAMAGE OF ANY KIND, ACTUAL OR CONSEQUENTIAL BY REASON OF THE VERIFICATION BY THE OWNER OF THE INFORMATION PROVIDED BY THE APPLICANT AND REPRESENTATIVES FROM ANY AND ALL KIND OF NATURE THAT MAY ARISE BY VIRTUE OF THE EXECUTION OF THIS AGREEMENT PROVIDED HEREIN. IN WITNESS WHEREOF THE PARTIES HERETO HAVE SET THEIR HAND ON THE DA TE FIRST WRITTEN BELOW DATE____________________APPLICANT__________________________________________