Cottage Application
Refundable fee: ($__500____) deposit
The Property is located at: 2053 Roswell Ave, Charlotte, NC 28207, USA. and is a ( ✓) House ( )
Condo ( ) Apartment ( ) which contains __ Bedroom(s), _one__ Bathroom(s). The Property includes
a ( ) Garden and ( ✓)___ Parking Space(s). Pets are ( ✓) allowed ( ) not allowed.
Smoking is ( ) allowed ( ✓) not allowed.
Check out time : 2PM
Rent per night $120
The Applicant
Full name
Date of Birth
Social Security number
Driver’s License number and State of Issue
Phone/ Mobile number
Email Address
Full name and Age of all Occupants
expected to live at the Property
Vehicles Registration number(s)
Have you or any listed Occupant ever filed
for Bankruptcy?
Have you or any listed Occupant ever been
convicted of a crime?
Have you or any listed Occupant ever
broken a lease?
Residence History
Employment
Current Employer
Current Occupation/ Title
Length of Employment (from and to)
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Name of Supervisor and their Phone
number
Current Monthly Income
Previous Employment
Previous Occupation/ Title
Length of Previous Employment
Name of Previous Supervisor and their
Phone number
Previous Monthly Income
Personal References
Financial Information
1. Bank
Account type (credit card, debit card,
savings etc)
Account number
Branch Location
2. Bank
Account type (credit card, debit card,
savings etc)
Account number
Branch Location
3. Bank
Account type (credit card, debit card,
savings etc)
Account number
Branch Location
Emergency Contact
Full name
Phone number
Address
Please state any further information you would like the owner to consider:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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Acknowledgement and Consent
I hereby confirm that I am aged 18 years or older. Applicant certifies that all statements
provided in this Rental Application are true, correct and complete. Applicant understands
failure to sign this application and provide true and complete information will create delays
in the application process and may cause the owner to reject the application. Applicant
hereby authorizes verification of all references and facts provided. Applicant confirms that
the owner may obtain any and all Credit Reports, Telechecks, Unlawful Detainer and or
Criminal Background Reports as the owner feels necessary.
Date:
Applicant’s Signature:
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