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Landlords
Tenant Credit Bureau of Michigan,
Inc.
2680
Horizon Dr., SE
Suite
B-2
Grand
Rapids, MI 49546
Phone
(616) 940-2508, Fax (616) 940-2512
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PLEASE
READ CAREFULLY
15.00 FEE CREDIT CHECK
Applicant
Authorization and Consent for Release of
Information
This
release and authorization acknowledges that Landlords Tenant Credit
Bureau may now, or at any time while
employed
conduct and inquiry.
This inquiry may include the following:
·
Employment
·
Credit
History
·
Motor
Vehicle Record
·
Criminal
History
·
Social
Security Verification
I/we
hereby authorize Landlord Tenant Credit Bureau and any of its agents
or attorneys to conduct an inquiry
authorized
by this release.
I/we
have read and understand this release and consent form, and I
authorize the background inquiry and
verification. I specifically authorize
present employer(s) and other organizations and/or agencies to
provide
all
information requested and I hereby release all of the persons or
entities providing such information from
any
photocopy of this document are as valid as the
original.
I/we
do hereby agree to forever release and discharge LANDLORDS
TENANT CREDIT BUREAU, its
employees,
and agents, from any claims, damages, losses, liabilities created by
the retrieval and reporting
of
the information authorized by this release.
Applicant
Name (printed): (First, Middle, Last)
Date
Signature
Social Security Number
Address
Date of Birth
City,
State, Zip
Phone Number (Home & Work)
Mailing
Address if Different
Driver License/I.D. Number
Co-applicant
Name (printed): (First, Middle, Last)
Date
Signature
Social Security Number
Address
Date of Birth
City,
Sate, Zip
Phone Number (Home & Work)
Mailing
Address if Different
IN COMPLIANCE WITH THE INTERNAL REVENUE CODE, SECT. 103 (B)
AND THE CITY OF
HOLLAND, LENDING INSTITUTES, APPLICANTS DESIRING TO
LEASE AND OCCUPY AN
APARTMENT ARE REQUIRED TO COMPLETE THE
FOLLOWING
APPLICATION FORM IN IT’S ENTIRETY.
Applicant’s
Household: List all household members
who will live in the rented premises.
Name
Age
Relationship
Occupation/School Grade
1.
2.
3.
4.
5.
Description of
All Vehicles:
Make/Model
Year
Color
License
Plate
State
1.
2.
3.
Rental
History:
Length of time
at current address and reason for moving:
Name and phone
number of present landlord:
Previous
address:
Length of time
at previous address and reason for moving:
Name and phone
number of previous landlord:
Have you ever
broken a lease?
Been
asked to leave?
Been
evicted?
If yes, please
explain:
Has any of your
security deposit been withheld by the landlord?
If yes,
what for?
Applicant’s
Employment/Financial Background:
Current
occupation:
Length
of Time:
(If less than
one year, please list previous employment on
reverse)
Employers name
& address:
Employer contact
name & telephone number:
Hourly rate:
Hours
per week:
Take
home amount per week:
Other sources of
income:
Co-Applicant’s
Employment/Financial Background:
Current
occupation:
Length
of Time:
(If less than
one year, please list previous employment on
reverse)
Employers name
& address:
Employer contact
name & telephone number:
Hourly rate:
Hours
per week:
Take
home amount per week:
Other sources of
income:
References (must
be other than family):
Name:
Phone:
(
)-
-
Address:
Name:
Phone:
(
)-
-
Address:
I AGREE THAT YOU
MAY OBTAIN AN INVESTIGATIVE CREDIT REPORT IN CONNECTION WITH THIS
APPLICATION. ($15 MUST BE SUBMITTED WITH
THIS APPLICATION FOR THE CREDIT REPORT.)
I ALSO AUTHORIZE YOU TO
OBTAIN AN EMPLOYMENT REPORT IN CONNECTION WITH THIS
APPLICATION.
I HAVE READ BOTH
PAGES OF THIS APPLICATION AND I HEREBY STATE AND REPRESENT THE
INFORMATION
PROVIDED BY ME IS COMPLETE AND ACCURATE. I ACKNOWLEDGE AND AGREE
THAT IN THE
EVENT I ENTER INTO A LEASE WITH MANAGING COMPANY FOR THE OWNER
AND IF ANY
INFORMATION HAS BEEN FALSIFIED THAT THE LEASE MAY BE BROKEN OR AT
ANY TIME THE
INFORMATION ABOVE CHANGES, I MUST NOTIFY THE MANAGING AGENT,
AT WHICH TIME IT
IS AT THE OPTION OF THE NANAGING AGENT TO ALLOW THE
CHANGES.
THE UNDERSIGNED
ALSO ACKNOWLEDGES THAT COMPLETING AN APPLICATION DOES NOT
AUTOMATICALLY
ENTITLE THEM TO AN APARTMENT.
THIS APPLICATION MUST BE APPROVED
PRIOR TO
ACCEPTANCE.
APPLICANT’S SIGNATURE
DATE
CO-APPLICANT’S SIGNATURE
DATE
PLEASE RETURN
TO: CARINI&ASSOCIATES REALTORS.INC
587 EAST 8TH STREET, SUITE A
HOLLAND, MICHIGAN, 49423
(616)
393-0444
(800) 411-6683 | 
