Rental Application

Rental Application

Please provide a copy of your ID and SS Card, at least 6 months of income and 1 year of rental history. A $150 Admin Fee will be charged at the time of the lease signing. Each adult (anyone over the age of 18) residing in a unit must complete an application. If you are interested in multiple properties, you only need to complete one application. A credit, reference and background check will be completed. Any applications that are incomplete will not be reviewed.
What address are you applying for*
If you are unsure, no problem, just list unsure. You only have to fill out one application. We do not require a new application for each property.
Expected Move-In Date

MonthDayYear
Date
Have you rented from us previously
Please list the address you lived at previously as well as an explanation as to why you left.
Have you dealt with a leasing agent? If so, please select one
Are you applying with anyone else*
Who are you applying with
Please list the full name of the person you are applying with
Name*

First NameMiddle NameLast NameSuffix
Are you a U.S. citizen*
Social Security #*
Tax ID # or Foreign ID number
Drivers License/ID#
Date of Birth*

MonthDayYear
Date
What is your e-mail address*
What is your cell phone number*
Please enter a valid phone number.
Do you have another phone number
Please enter a valid phone number.
Current housing status
What is your current address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for leaving current address/landlord*
Length at current Address*

Less than 1 year1-2 Years2-3 Years3-5 YearsMore than 5 Years
Current Landlords Name
Current Landlords Phone #
Please enter a valid phone number.
Current Landlord e-mail
example@example.com
Previous Address if Less than 2 Years

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for leaving previous address/landlord*
Previous landlords name
Previous landlords phone #
Please enter a valid phone number.
Length at Previous Address

Less than 1 year1-2 Years2-3 Years3-5 YearsMore than 5 Years
Current employment status*
Current employer name
Employers phone #
Please enter a valid phone number.
Length at current employer
Primary source of income

EmploymentSelf EmploymentSSIDisabilityChild SupportRetirementOtherNo Income
Primary monthly income
Secondary source of income

Second/Third JobSelf EmploymentSSIDisabilityChild SupportRetirementOther
Monthly secondary income
Have you ever had an eviction filed against you
Have you ever filed for bankruptcy
Have you ever been convicted of a felony
Please explain the felony (or felonies)
Do you have any pets
How many pets do you have
Please list the types, breed and names of each pet
Emergency contact name

First NameLast Name
Emergency contact phone
Please enter a valid phone number.
Do you have any children under 18 living with you
Please list the names of all children living with you
Do you have a Section 8/housing choice voucher
If yes, please list the agency that issued the voucher

NLR HousingPulaski County HousingJacksonville HousingLonoke County HousingOther
Please upload a copy of your state ID, drivers license or passport*

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Please upload 2 most recent paystubs and/or 2 most recent bank statement(s)*

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Please upload a copy of your social security card or tax identification*

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Please upload a copy of your current tenant ledger showing you previous payment history to your current landlord

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My Products*

USDApplication Fee $25

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigation (including a criminal background check, reference check and a credit check) of all statements contained in this application for tenant screening as may be necessary in arriving at a tenant decision, I understand that the landlord may terminate any rental agreement entered into for any misrepresentations made on this form.
Applicants Signature*

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