Harvest Glen Apartments
Date____/_____/_____
Type of Apartment Desired: Studio_____ 1BR_____ 2BR_____ 3BR_____
Garden_____ Townhouse_____
Date Occupancy Desired: _____/_____/_____
Agent__________________ Traffic Source___________
Apartment Occupants (Note: All adults to occupy apartment must sign the
lease)
Name (Head of Household) Phone #: Date of Birth
[ ] Male Marital Status: [ ] Married Social Security No. ___/__/___
Email: [ ] Female [ ] Separated [ ] Single
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/__ _ [ ] Female [ ] Other [ ] Child
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/___ [ ] Female [ ] Other [ ] Child
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/___ [ ] Female [ ] Other [ ] Child
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/___ [ ] Female [ ] Other [ ] Child
In Case of Emergency-Notify: (Nearest relatives not living with you)
Name Address Phone Relationship
City/State/Zip
Name Address Phone Relationship
City/State/Zip
Complete The Following Where Applicable:
Employment
Present Employer (Name of Company) Address
Business Phone: Supervisor's Name Phone: Your Position
How Long? Gross Income: $ [ ] Year [ ] Month
Former Employer Address Business Phone:
Supervisor's Name Phone: Your Position How Long?
Gross Income: $ [ ] Year [ ] Month
Spouse's Present Employer Address Business Phone:
Supervisor's Name Phone: Your Position How Long?
Gross Income: $ [ ] Year [ ] Month
Other Income (i.e. part-time job, assistance, disability, pensions, etc.)
Source Monthly Gross: $ Source Monthly Gross: $ Source
Monthly Gross: $ Income from alimony, child support or maintenance payments need not
be revealed if you choose not to disclose such income.
Is any of the above monthly income derived from
alimony, child support or maintenance payments? [ ] Yes [ ] No
Residence History
Present Address Apt./Landlord/Mortgage Name
Business Phone How Long?
Monthly Payments $ Reason for moving from Present Address:
[] Better Location
[] Price
[] Job Transfer
Former Address Apt./Landlord/Mortgage Name
Business Phone How Long?
Monthly Payments $ Reason for moving from Former Address:
[] Management
[] Maintenance
[] Job Transfer
[] Other
Auto(s)-Motocycle-Boat-Camper/RV-Pet-Liquid-Filled Furniture
Driver's License #: State: Spouse's Driver's Licence #: State:
Auto(s): Make- Year- Lic. Plate #/State:
Auto(s): Make- Year- Lic. Plate#/State:
Auto(s): Make- Year- Lic. Plate #/State:
Auto(s): Make- Year- Lic. Plate #/State:
Liquid-Filled Furniture: [ ] No [ ] Yes- explain Pets: [ ] No [ ] Yes-Type: Weight:
Motorcycle: [ ] No [ ] Yes-Make Boat: [ ] No [ ] Yes-Size/Make
Camper/RV: [ ] No [ ]Yes- Make
Date____/_____/_____General
Have you or your spouse ever been sued? [ ] No [ ] Yes-If yes,
explain:
Have you or your spouse ever filed bankruptcy? [ ] No [ ] Yes-If yes,
explain:
Have you or your spouse been convicted of a felony within the last ten (10) years? [ ] No [ ] Yes-If yes
explain:
Use this area for any additional information you feel might expedite your
application:
1. I hereby apply for and offer to lease the apartment described herein for the lease term stated, at the
rental and upon the terms and conditions set forth herein and in Lessor’s standard lease form. I warrant
that all of the representations in this application are true and correct.
2. I understand that occupancy of the apartment is limited to persons listed above under “Apartment
Occupants”. I understand that if children are occupants of the premises it is my responsibility to supply
adequate supervision at all times.
3. Simultaneously with the execution of the application I am making a deposit of $__________plus
$__________ charge for an investigative report, it being understood that the charge for the investigative
report is not refundable. Upon execution of the lease by me it is understood that this deposit will be
retained by the Lessor and applied to the Security Deposit under the terms and conditions contained in
the lease. It is further understood that at the time I execute the lease on the premises I will pay the first
month’s rental and the balance of the Security Deposit. I understood that a covenant of the lease requires
rental payments on or before the first day of each and every month thereafter in
advance.
4. I agree that the Lessor may retain said deposit as liquidated damages for its costs and expenses,
and not as a penalty, if any of the representations made by me herein are false. I further agree that my
deposit is non-refundable (except for the provision of paragraph 5 herein) and the deposit will be retained
if an apartment is held for me for more than seventy-two (72) hours from the inception date of the
application and I do not execute a lease for the apartment described herein (or any other apartment
mutually agreed upon).
5. I understand that Lessor will refund said deposit to me if the apartment specified (or any other
apartment mutually agreed upon) is not available, or if the is application is rejected by the Lessor for any
reason.
6. I understand that I acquire no rights on any apartment until I sign a lease in the form submitted to me,
until all monies are paid to the Lessor as set forth above; and the lease is executed by
Lessor.
7. As is customary in the business, I understand that routine inquires may be made with respect to my
tenancy. In compliance with Fair Credit Reporting Act, I understand that an investigative consumer report
will be made which may include information as to my character, general reputation, personal
characteristics and mode of living. The nature and scope of the investigation requested may include
information obtained through personal interviews concerning residence verification, marital status,
number of dependents, employment, occupation, habits, reputation and mode of
living.
8. I understand that my application may be rejected if during the investigation there are found to be
judgments, lien(s), or bankruptcy in my personal credit history.
9. I agree to submit to Lessor valid photo identification (such as state driver’s
license).
10. Liquid-filled furniture (waterbeds, etc.), boats, campers/RVs and/or pets are not allowed without prior
written authorization.
The term “Lessor” shall include the Owner-Landlord and Matrix Capital Partners as managing agent and
any affiliate, agent or employee thereof.
Signature:
_______________________________________Date______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Authorized Agent
Rev. 8/10 Date____/_____/_____
Date____/_____/_____
Type of Apartment Desired: Studio_____ 1BR_____ 2BR_____ 3BR_____
Garden_____ Townhouse_____
Date Occupancy Desired: _____/_____/_____
Agent__________________ Traffic Source___________
Apartment Occupants (Note: All adults to occupy apartment must sign the
lease)
Name (Head of Household) Phone #: Date of Birth
[ ] Male Marital Status: [ ] Married Social Security No. ___/__/___
Email: [ ] Female [ ] Separated [ ] Single
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/__ _ [ ] Female [ ] Other [ ] Child
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/___ [ ] Female [ ] Other [ ] Child
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/___ [ ] Female [ ] Other [ ] Child
Name Date of Birth [ ] Male Relationship: [ ] Spouse
Social Security No. ___/__/___ [ ] Female [ ] Other [ ] Child
In Case of Emergency-Notify: (Nearest relatives not living with you)
Name Address Phone Relationship
City/State/Zip
Name Address Phone Relationship
City/State/Zip
Complete The Following Where Applicable:
Employment
Present Employer (Name of Company) Address
Business Phone: Supervisor's Name Phone: Your Position
How Long? Gross Income: $ [ ] Year [ ] Month
Former Employer Address Business Phone:
Supervisor's Name Phone: Your Position How Long?
Gross Income: $ [ ] Year [ ] Month
Spouse's Present Employer Address Business Phone:
Supervisor's Name Phone: Your Position How Long?
Gross Income: $ [ ] Year [ ] Month
Other Income (i.e. part-time job, assistance, disability, pensions, etc.)
Source Monthly Gross: $ Source Monthly Gross: $ Source
Monthly Gross: $ Income from alimony, child support or maintenance payments need not
be revealed if you choose not to disclose such income.
Is any of the above monthly income derived from
alimony, child support or maintenance payments? [ ] Yes [ ] No
Residence History
Present Address Apt./Landlord/Mortgage Name
Business Phone How Long?
Monthly Payments $ Reason for moving from Present Address:
[] Better Location
[] Price
[] Job Transfer
Former Address Apt./Landlord/Mortgage Name
Business Phone How Long?
Monthly Payments $ Reason for moving from Former Address:
[] Management
[] Maintenance
[] Job Transfer
[] Other
Auto(s)-Motocycle-Boat-Camper/RV-Pet-Liquid-Filled Furniture
Driver's License #: State: Spouse's Driver's Licence #: State:
Auto(s): Make- Year- Lic. Plate #/State:
Auto(s): Make- Year- Lic. Plate#/State:
Auto(s): Make- Year- Lic. Plate #/State:
Auto(s): Make- Year- Lic. Plate #/State:
Liquid-Filled Furniture: [ ] No [ ] Yes- explain Pets: [ ] No [ ] Yes-Type: Weight:
Motorcycle: [ ] No [ ] Yes-Make Boat: [ ] No [ ] Yes-Size/Make
Camper/RV: [ ] No [ ]Yes- Make
Date____/_____/_____General
Have you or your spouse ever been sued? [ ] No [ ] Yes-If yes,
explain:
Have you or your spouse ever filed bankruptcy? [ ] No [ ] Yes-If yes,
explain:
Have you or your spouse been convicted of a felony within the last ten (10) years? [ ] No [ ] Yes-If yes
explain:
Use this area for any additional information you feel might expedite your
application:
1. I hereby apply for and offer to lease the apartment described herein for the lease term stated, at the
rental and upon the terms and conditions set forth herein and in Lessor’s standard lease form. I warrant
that all of the representations in this application are true and correct.
2. I understand that occupancy of the apartment is limited to persons listed above under “Apartment
Occupants”. I understand that if children are occupants of the premises it is my responsibility to supply
adequate supervision at all times.
3. Simultaneously with the execution of the application I am making a deposit of $__________plus
$__________ charge for an investigative report, it being understood that the charge for the investigative
report is not refundable. Upon execution of the lease by me it is understood that this deposit will be
retained by the Lessor and applied to the Security Deposit under the terms and conditions contained in
the lease. It is further understood that at the time I execute the lease on the premises I will pay the first
month’s rental and the balance of the Security Deposit. I understood that a covenant of the lease requires
rental payments on or before the first day of each and every month thereafter in
advance.
4. I agree that the Lessor may retain said deposit as liquidated damages for its costs and expenses,
and not as a penalty, if any of the representations made by me herein are false. I further agree that my
deposit is non-refundable (except for the provision of paragraph 5 herein) and the deposit will be retained
if an apartment is held for me for more than seventy-two (72) hours from the inception date of the
application and I do not execute a lease for the apartment described herein (or any other apartment
mutually agreed upon).
5. I understand that Lessor will refund said deposit to me if the apartment specified (or any other
apartment mutually agreed upon) is not available, or if the is application is rejected by the Lessor for any
reason.
6. I understand that I acquire no rights on any apartment until I sign a lease in the form submitted to me,
until all monies are paid to the Lessor as set forth above; and the lease is executed by
Lessor.
7. As is customary in the business, I understand that routine inquires may be made with respect to my
tenancy. In compliance with Fair Credit Reporting Act, I understand that an investigative consumer report
will be made which may include information as to my character, general reputation, personal
characteristics and mode of living. The nature and scope of the investigation requested may include
information obtained through personal interviews concerning residence verification, marital status,
number of dependents, employment, occupation, habits, reputation and mode of
living.
8. I understand that my application may be rejected if during the investigation there are found to be
judgments, lien(s), or bankruptcy in my personal credit history.
9. I agree to submit to Lessor valid photo identification (such as state driver’s
license).
10. Liquid-filled furniture (waterbeds, etc.), boats, campers/RVs and/or pets are not allowed without prior
written authorization.
The term “Lessor” shall include the Owner-Landlord and Matrix Capital Partners as managing agent and
any affiliate, agent or employee thereof.
Signature:
_______________________________________Date______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Co-Applicant
Signature:___________________________________________________
Date:______/______/______
Authorized Agent
Rev. 8/10 Date____/_____/_____
