APPLICATION FOR LEASE

APPLICATION FOR BLDG. ADDRESS ______________________________________ APT #____________ BASE RENT $ _____________________/MO.
LEASE TERM FROM ____________ TO ______________.

Leasing Agent or Broker: ____________________________________________________

Contingency/Promo:_______________________________________________________________________________________________________________
_

APPLICANT INFORMATION: (Please Provide Copy of Government-Issued Photo I.D.)

APPLICANTS NAME: (Last) ___________________________________________ (First) ____________________________________________
Social Security No.___________________ DL/ST I.D.# _______________________State of Issue _____DATE OF BIRTH____/______/_______
Email address ___________________________________ DAY TELEPHONE _______________________ CELL __________________________
OCCUPANT MIX: No. of Adults _______ No. of Children ________ Names and ages of minors_________________________________________
DO YOU HAVE ANY PETS?

NO or

YES If so, how many and what kind of pet? ________________________________________________

APPLICANTS CURRENT ADDRESS: (Applicant Must Complete the Landlord Verification Form)
Street _______________________________________ APT #_______ City ___________________
LENGTH OF CURRENT TENANCY: _____________ YEARS and/or ____________ MONTHS.

State _______ Zip ________________

MONTHLY RENT: $_____________________

CURRENT LANDLORD NAME: ________________________________ DAY TELEPHONE ________________________________________

Sharing Apartment?

NO or

YES

Reason for Moving: ____________________________________________________________________

1.

Have eviction proceedings ever been filed against you? ___NO or ___ YES

2.

Do you have any reason to believe that any of your personal property has been exposed to or infested with bed bugs? ____NO or ____YES
Please explain clearly.

If yes, explain on back of this form.

3. Have you ever been convicted of a crime? ____NO or ___YES If yes, explain ______________________________________________
____________________________________________________________________________________________________________________

APPLICANTS FORMER ADDRESS:

Street _______________________________________ APT #_______ City ___________________

State _______ Zip _________________

LENGTH OF TENANCY: ___ Yrs and/or ____ Mos. MONTHLY RENT:$_________ LANDLORD TELEPHONE: ___________________________

APPLICANTS INCOME INFORMATION: (Applicant Must Complete the Income Verification Form)
Company Name ____________________________________________________

Phone _________________________________________

Address __________________________________________________________

Monthly Gross Income $__________________________

City _________________________ State _____ Zip ____________ Position __________________________ Date of Hire _______________
Supervisors Name _________________________________________________

Supervisors Phone _______________________________

OTHER INCOME/ASSETS: (alimony, ssi, loans, child support or any income you want to consider to help determine your income eligibility.)
Monthly Income Amount

Type

Received from

Phone

_______________________________________________________________________________________________________________________________________

**HOW DID YOU HEAR ABOUT US? _____________________________________

I certify that all of the information in this application is true and correct. I understand that:

(1) The Application Fee of $50.00 per applicant is NON-REFUNDABLE for any reason.
(2) The Document Processing Fee of $250.00 is NON-REFUNDABLE, unless this application is denied by Lessor. I understand and accept that the waiting
period for any refunds is ten (10) business days from the date of denial of the application.
(3) I agree to pay the first full months rent via certified funds or Credit card within 24 hours of notification of approval of my application. I further understand
that my approval may be revoked and I will not be refunded the Document Processing Fee if I do not pay the first full months rent within the period described
here in.
(4) If applicant cancels or withdraws this application for lease, the document processing fee and the application fees will not be refunded and will be used, as
liquidated damages, to offset the costs incurred by Horizon Realty Group (HRG and/or its agents and third party brokers, if applicable. I understand that this
application shall be incorporated in and become part of the Lease for the premises sought and if incorrect or untrue shall be grounds for termination of the
Lease. By my signature below, I certify that the information contained herein is true and correct. I authorize HRG and/or its third party brokers to investigate
and verify the information contained herein, and obtain an investigative consumer report, credit report, which may include information as to my character and
general information. I authorize HRG to verify my income and landlord/mortgage histories.

APPLICANT SIGNATURE X___________________________________Date _________________

Revised 3-11-16

APPCODE:______________________

Income Verification Form

Notice to Applicant:
Leaving fields blank will cause a delay in the processing of your application. Please fill out all areas completely and if not applicable
denote as N/A (please print clearly)
FACSIMILE TRANSMITTA L SHEET
TO: (INCOME VERIFIERS NAME)

FROM: HORIZON REALTY GROUP-PROCESSING DEPT.

INCOME VERIFIERS FAX NUMBER:

TOTAL NO. OF PAGES INCLUDING COVER:

INCOME VERIFIERS PHONE NUMBER:

I, (Please Print Full Name) ___________________________________________________________, hereby authorize all necessary

information, as indicated below, to be released to Horizon Realty Group, Inc. and its agents for their exclusive use.
X_______________________________________________
Signature of Applicant

Date _______________________________

Applicants SSN:________________________________ DOB __________________________

Below section is to be filled out by the income verifier only.

Attention: Human Resource Department or _______________________________________________________

To whom it may concern:

The above named individual (applicant) has applied for tenancy with Horizon Realty Group, Inc. In
order to complete the application process, we need to verify his/her income information. Information
contained on this form will only be used in accordance with the Fair Credit Reporting Act. Your quick
attention to this matter is appreciated.
1.
2.
3.
4.

Employment/Income start date: ___________________________________

Full-time employee?____________________
How many hours/wk? ___________________
Present salary/pay rate?________________________________ per____________________________
Additional compensation projected for the next 12 months? (please
specify)________________________________________________________________________________
5. Probability of continued employment____________________________________________________
6. Other comments:_______________________________________________________________________
X_______________________________________________________
Date_______________________
Authorized Verifiers Signature
Authorized verifiers name: (please print) __________________________Title_______________________
PLEASE RETURN THIS FORM VIA FAX to: HORIZON REALTY GROUP AT 773-529-7201
1946 W Lawrence Ave

Chicago, IL

60640

Office 773-529-7200

Fax 773-529-7201

APPCODE: __________________

Landlord Verification Form

Notice to Applicant:
Leaving fields blank will cause a delay in the processing of your application. Please fill out all areas completely and if not applicable
denote as N/A (please print clearly)
FACSIMILE TRANSMITT AL SHEET
TO: (LANDLORD/VERIFIERS NAME)

FROM: HORIZON REALTY GROUP-PROCESSING DEPT.

LANDLORD/VERIFIERS FAX NUMBER:

TOTAL NO. OF PAGES INCLUDING COVER:

LANDLORD/VERIFIERS PHONE NUMBER:

I, (Please Print Full Name) ___________________________________________________________, hereby authorize all necessary

information, as indicated below, to be released to Horizon Realty Group, Inc. and their agents for their exclusive use.
X_______________________________________________
Signature of Applicant

Date _______________________________

Attention Landlord, Managing Agent or to whom it may concern:

The above named individual (applicant) has applied for tenancy with Horizon Realty Group, Inc. In order to complete the application process,
we need to verify her tenant information. Information contained on this form will only be used in accordance with the Fair Credit Reporting Act.
Your quick attention to this matter is appreciated.
Address to be verified: ______________________________________City_______________ ST____ Zip_____________
1.
2.
3.
4.
5.

Lease (d) from: ____________________ to ____________________________ Fulfilling term?__________

Monthly Rent____________________
Paid on time? ___________________________________________
If not paid on time, how many times late?____________________________________________________
Other occupants, pets, roommates, cosigners?______ If so, please specify:_________________________________
Has tenants apartment been treated for bed bugs? __________. Have you experienced any bed bug issues in tenants apartment
or in the building that tenant occupies? _______________________. If yes, please explain_________________________
____________________________________________________________________________________________________
6. Any complaints about the tenant? ___________________________________________________________
7. Any other comments:____________________________________________________________________________

X_______________________________________________________
Authorized Verifiers Signature

Date_______________________

Authorized verifiers name: (please print) ________________________________Title________________________

PLEASE RETURN THIS FORM VIA FAX to: HORIZON REALTY GROUP AT 773-529-7201
1946 W Lawrence Ave

Chicago, IL

60640

Office 773-529-7200

Fax 773-529-7201