apartment/home rental application

P.O. Box 5585

Poland, OH 44514

e-mail : info@blueroseproperties.com

Phone:  (330)294-5444

 Name:________________________________________________________________ SSN#________-________-_________

Drivers License#________________________________________________________________________________

Name: _________________________________________________________________SSN#: ________-_______-_________

Drivers License#___________________________________________ 

Employer:___________________________________ ______Address:___________________________________________________

Phone#__________________________Position__________________________________________________How long____________

Supervisor:__________________________________________________________Business Phone: ____________________________ 

Monthly Income:  ___________________ Child support/Alimony $_________________Gov’t assistance $____________________

Have you ever been party to an eviction? [  ] yes [  ] No Have you ever been convicted of a felony? YES / NO

If yes, explain conviction: ____________________________________________________________________________________ 

Personal References

Name:___________________________________________________Yrs Known_____Phone #________________________

Relationship ___________________________________________________________

Name___________________________________________________Yrs Known____ Phone #________________________

Relationship _________________________________________________________ 

Name__________________________________________________ Yrs Known_____Phone #_________________________

Relationship__________________________________________________________ 

I represent that the information provided in this Application is true and correct to the best of my knowledge.  Blue Rose Properties, LLC, and their employees, associates, and partners, is authorized to verify the references and employment information given in this application.  If Blue Rose Properties, LLC decides to rent you the apartment, or house, please understand that the rent is due on or before the first day of the month.  There are no exceptions to this rule.  If the first falls on either a Sunday or a Holiday; your  rent is due the day before the first day of the month.  If the rent is not paid by the first of the month, there will be a 3-day eviction notice issued on the second day of the month.   

Sign______________________________________________________________ Date ___________________________________

 Co-Applicant’s Signature_________________________________________________________________________Date______________________   

IT IS AGAINST THE LAW TO DISCRIMINATE AGAINST PROSPECTIVE TENANTS ON THE BASIS OF RACE, RELIGION, NATIONAL ORIGIN, AGE, OR DISABILITY.  LOCAL OR STATE LAWS MAY INCLUDE