The Pointe Management Company
The Pointe Management Company

POINTE MANAGEMENT RENTAL APPLICATION
APPLICANT’S INFORMATION

APPLICANT'S INFORMATION
Applicant's Name
First Name
 		Middle Name
 		Last Name
Date of Birth
Place of Birth
Email Address
NOTE: Applicant must be 19 in the State of Nebraska
Social Security Number, or Green card/VISA
(Copy of SS Card or alternative Document with SS# may be required)
 		State
Driver's License Number
(Copy of license required at move in if no license, state issued photo ID)
 		Issuing State
Apartment Complex:
NOTE: Please complete last three (3) years of residency.
Present Address
Street
City
 		State
 		Zip Code
 		County
Home Phone
Work Phone
 		Cell Phone
 
Landlord/Mortgagee
Name
 		Phone Number
 		Length of Residency
(# of mo) 		   Rent/Mortgage
$ /month
Street
City
 		State
 		Zip Code
 		County
Previous Address
Street
City
 		State
 		Zip Code
 		County
 
Landlord/Mortgagee
Name
 		Phone Number
 		Length of Residency
(# of mo) 		   Rent/Mortgage
$ /month
Street
City
 		State
 		Zip Code
 		County
Previous Address
Street
City
 		State
 		Zip Code
 		County
Landlord/Mortgagee
Name
 		Phone Number
 		Length of Residency
(# of mo) 		   Rent/Mortgage
$ /month
Street
City
 		State
 		Zip Code
 		County
EMPLOYMENT INFORMATION
Current Employer
Supervisor
Street
City
State
Zip Code
Period of Employment

From               To
 		Phone Number
 		   Monthly Income
$ 		Position
Other Sources of Income
 		   Current Total
   Annual Income
$
Previous Employer
Supervisor
Street
City
State
Zip Code
Period of Employment

From               To
 		Phone Number
 		   Monthly Income
$ 		Position
VEHICLE & PERSONAL INFORMATION
Year  
 		Make
 		Model
 		License Number
 		State
Year
Make
 		Model
 		License Number
 		State
Emergency Contact #1
(Other Than Occupants)
  		Relationship
  		Phone Number
 
Complete Address
Emergency Contact #2
(Other Than Occupants)
  		Relationship
  		Phone Number
 
Complete Address
PERSON(S) OTHER THAN APPLICANT TO OCCUPY APARTMENT
(A Guarantor or Person(s) of legal adult age living in apartment are required to complete a Rental Application as well - minors and/or children under the age of 19 are not required to complete Rental Application)
Applicant's Name
 Total Number of person(s) to occupy apartment 

Total Number of person(s) to occupy apartment
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Name
 		Relationship
 		Age
Will anyone in your household require special living accommodations or have special needs?  No Yes
If yes please explain:
Has anyone in your household ever been evicted, sued for rent, sued for property damage or ever broken a lease for any reason?  NO YES
If yes please explain:
Has anyone in your household ever failed to pay a debt, rent or judgment?   NO YES
If yes please explain:
Have you, or anyone else who is to occupy the apartment, ever been convicted, pled guilty, no contest, received probation, deferred adjudication, court-ordered supervision, or pre-trial diversion for a felony, sex-related crime, or misdemeanor assault against another person? NO YES
If yes please explain:
Do you own any pets?   NO YES  If yes, Type  Lbs. 
How did you hear about us?
Apartment Guide
Referral
Drive By/Walk By
For Rent Magazine

Pointemanagementco.com
Web Site
Newspaper
Other    

Apartment Finders
Phone Book

APPLICATION IS NOT COMPLETE UNLESS AUTHORIZATION FORM BELOW IS SIGNED AND DATED
 

I hereby make application to lease and agree that the rent is payable the first of each month in advance.  As consideration, I paid a deposit and application fee.  Balance of deposit to be paid upon execution of the lease unless otherwise stated in the lease.  I understand that, in addition, my application fee will be retained, to offset The Pointe Management Company’s cost, time, and effort in processing my application.  Upon acceptance of this application, I agree to execute a lease.  I recognize that, as part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained regarding my credit history, employment history, criminal history, and housekeeping history.  This inquiry includes information as to my character, reputation, personal characteristics and mode of living.  I understand that I may have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigation.  Any false or incomplete information will result in the denial of your application.  If discovered after you are approved and have moved in, we reserve the right to terminate your tenancy.  In the event this application is accepted, but I subsequently refuse to sign a lease and/or take possession of the premises, the deposit will be forfeited as damages.  I state that the information I have provided is true and correct to the best of my knowledge.

Applicant's Electronic Signature*                                       Date*
        

* Electronic Signature
I declare under penalties of perjury that I have examined this filing, and to the best of my knowledge and belief the information I have provided is correct, complete and legally binding upon me. By typing in my name on this application, I agree to conduct business electronically in accordance with the federal Electronic Signatures in Global and National Commerce Act (E-Sign), 15 U.S.C.A. §§ 7001-7031 (Supp. 2001). I further understand that transactions and/or signatures in records may not be denied legal effect solely because they are conducted, executed or prepared in electronic form, and that if a law requires or permits a record or signature to be in writing, an electronic record or signature satisfies that requirement.

I acknowledge and freely consent that my typed-in name on this application shall constitute a binding electronic signature under the laws of the United States. I recognize that I may be entitled to a paper or other non-electronic form of this document. I understand that prior to my signing this application I can request printed copies should I wish to be supplied with such document copies.

This form is an application for housing.  I hereby certify, to the best of my knowledge or belief, that the information in the application is accurate and I agree to comply with the applicable ordinance.

     

 
©2005 Pointe Management Company. All rights reserved. pointemanagement@qwest.net