DISCLOSURE
PLEASE READ CAREFULLY BEFORE SIGNING
1. APPLICANT UNDERSTANDS THAT ________________________________________________________________ IS
THE LEASING AGENT AND REPRESENTATIVE FOR THE LANDLORD OF THE PREMISES LOCATED AT
_________________________________________________________________ AT A MONTHLY RENT OF $_____________.
2. APPLICANT DECLARES THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT, AND
APPLICANT AUTHORIZES AN EMPLOYMENT CHECK, CRIMINAL RECORDS CHECK, CREDIT CHECK, VERIFICATION
OF REFERENCES AND CURRENT AND PREVIOUS LANDLORDS.
3. APPLICANT HEREBY PAYS $_____________ AS A NON-REFUNDABLE APPLICATION FEE AND $____________
AS HOLDING FEE. IF APPLICANT IS DECLINED, THE HOLDING FEE MAY BE REFUNDED WITHIN ____ BUSINESS
DAYS. IF, AFTER APPROVAL, APPLICANT DECIDES NOT TO FULFILL THIS AGREEMENT BY COMPLETING
LEASE AND PAYING FIRST MONTHS RENT AND REMAINING SECURITY DEPOSIT, HOLDING FEE SHALL BE
RETAINED BY LANDLORD TO COVER ADMINISTRATIVE EXPENSES.
4. APPLICANT AGREES TO EXECUTE A RENTAL AGREEMENT BEFORE POSSESSION IS GIVEN AND TO PAY
THE RENT AND SECURITY DEPOSIT WITHIN ____ BUSINESS DAYS AFTER BEING NOTIFIED OF ACCEPTANCE OF
THIS APPLICANT.
5. LANDLORD AND AGENT WILL NOT BE BOUND BY ANY REPRESENTATIONS, AGREEMENTS OR
PROMISES, WRITTEN OR ORAL, MADE BY LANDLORD OR AGENT UNLESS CONTAINED IN THE RENTAL
AGREEMENT SIGNED BY LANDLORD OR LANDLORD’S AGENT.
6. APPLICANT HAS REVIEW ED THE PUBLIC RECORD INFORMATION ON THE ____________________
COUNTY RECORDER’S WEBSITE SHOWING THE POSSIBILITY OF PAST OR CURRENT LIENS RECORDED AGAINST THE
PROPERTY AS OF THE DATE OF THIS APPLICATION. APPLICANT AGREES TO LEASE THE PROPERTY SUBJECT TO
THIS INFORMATION, AND HOLD THE LANDLORD AND ITS AGENTS HARMLESS BASED UPON THIS INFORMATION
AND FUTURE USE OF THE PROPERTY.
7. APPLICANT DOES HEREBY RELEASE LANDLORD, AGENT AND THIS COMPANY FROM ANY AND
ALL DAMAGES OR LIABILITIES W HICH MIGHT RESULT FROM THE ABOVE INFORMATION. APPLICANT
RELEASES PRESENT LANDLORD AND ALL PREVIOUS LANDLORDS FROM ANY AND ALL LIABILITY FOR ANY
DAMAGE OR INJURY WHATSOEVER CAUSED BY PROVIDING INFORMATION TO LANDLORD OR AGENT REGARDING
APPLICANT.
8. APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT A FALSE STATEMENT MADE HEREIN IS GROUNDS
FOR DENIAL OF RENTAL TO APPLICANT. ANY STATEMENT HEREIN MAY BE CONSTRUED AS A
CONDITION PRECEDENT TO ANY BINDING RENTAL AGREEMENT OR CONTRACT BETWEEN APPLICANT AND
LANDLORD.
9. APPROVAL FOR RESIDENCY IS MADE W ITHOUT REGARD TO RACE, COLOR, RELIGION, SEX,
NATIONAL ORIGIN, AGE, GENDER IDENTITY OR EXPRESSION, FAMILIAL STATUS, SEXUAL ORIENTATION,
ANCESTRY, OR HANDICAP..
10. APPLICANT UNDERSTANDS THAT APPLICANT ACQUIRES NO RIGHTS TO PREMISES UNTIL EXECUTION OF A
RENTAL AGREEMENT IN THE FORM SUBMITTED AND DEPOSIT OF RENT AND SECURITY DESCRIBED ABOVE.
SIGNATURE OF APPLICANT ________________________________________ DATE ____________ TIME ____________
SIGNATURE OF CO-APPLICANT _____________________________________ DATE ____________ TIME ____________
OFFICE USE ONLY:
REFERRAL COMPANY _______________________________________ MLS # _______________ DATE PAID __________
AGENT:______________________________________P.I.D#____________________ LICENSE # ______________________
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