LEASE APPLICATION || BRICK CITY

LEASE APPLICATION

Each adult applicant must complete the application below.

(NOTE: Each adult person that will reside in the rental property (occupants) must complete and sign a separate application form) (NOTE: All requests for information as set forth in this Application must be provided and any omission or misrepresentation of any information is automatic grounds for rejection of this application) (NOTE: Lessor does not deny or reject applications on the basis of race, color, religion, national origin, sex, ancestry, age, marital status, physical or mental handicap, familial status or any other class protected by Article 3 of the Illinois Human Rights Act or federal law.):

First and Middle names

Last name

Address

Phone

Birthday

Month

Day

Year

Social security #

xxx-xx-xxxx

Driver's License or State ID

Current Landlord (include address and phone number and/or email address for them)

Last Previous Landlord (include address, phone number and/or email address for them).

Employer and employer address

Position/Job Title and length of employment

Monthly Gross (not take home) Income

Name, address, and phone number of nearest living relative, not living with you, in case of emergency.

Have you ever been arrested, charged, or convicted of a criminal offense (excluding parking or traffic citations or juvenile matters)? (Check only one)

Yes

If yes, please explain. If no, just write "N/A".

Have you ever been evicted or a lawsuit filed against you for eviction? (Check only one)

Yes

If yes, please explain. If no, just write "N/A".

Have you ever, besides eviction, had a civil law suit filed against you (example: for money owed, etc)? (Check only one)

Yes

If yes, please explain. If no, just write "N/A".

Do you have pets? (Check only one) NOTE: Lessor does not allow animals in leased premises without written permission of Lessor

Yes

If yes, the type of animal and their breed. If no, just write "N/A".

By signing, I the undersigned applicant consents to and authorizes Brick City, LLC, its employees, contractors and agents, to obtain a copy of my credit report/history from the Credit Bureau or other any other applicable or similar consumer reporting agency and/or obtain any information from my current or any previous lessor or any other source. By signing, I the undersigned applicant understand that it is not a lease agreement, that no lease agreement is created herein and that I am at most a prospective tenant or occupant. By signing, I the undersigned understand that any fee paid by me is non-refundable, regardless of whether this application is approved or denied. By signing, I understand that in the event that my application is approved and a lease agreement is signed by me as a tenant that I must comply with all pre-possession conditions of the lease agreement. By signing, I represent that I have answered the above questions fully and truthfully. I understand that any misrepresentation of information on this application is grounds for eviction pursuant to the terms of the lease agreement.

Date and time

Month

Day

Year

Time

HoursMinutes

By signing, I the undersigned applicant consents to and authorizes Brick City, LLC, its employees, contractors and agents, to obtain any information from my current or any previous lessor or any other source.

Signature field is empty.