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SS Land Ties

RENTAL APPLICATION
We appreciate your interest in our rental property. We have been in the rental business for some time
now and participate in the Good Landlord program. We have come to see that not everyone is as they
may appear or as they speak. Therefore, we “screen” our applicants through a screening service. There
is a $35 non-refundable application fee to pay for a screening check and credit search for each adult 18
years applying to reside in this residence.

These checks help us encourage peaceful, pleasant, responsible tenants. They are not always accurate
or absolutely correct but they provide a good starting point. People do change, but, we know that
people who are concerned about their history or their behaviors will likely not apply or pay the
application pee when they understand their history will be checked.

If you have any concerns or questions about the process that we use then feel free to contact us.

SUBMISSION OF APPLICATION: Applications may be mailed with application fee to the following
address: SS Land Ties c/o Bill Shaw; 166 Ashe Dr.; Brigham City, Utah 84302

IDENTIFICATION: All applicants over the age of 18 must provide a current photo identification at the
time of application and when signing the lease.

EMPLOYMENT REQUIREMENTS: Employment will be verified. Employment history must demonstrate


reliability and stability.

RENTAL HISTORY: Applicants must provide name, address and dates of tenancy for the previous
landlords for the past two years. An application will not be approved if there are any previous evictions,
defaults in lease agreements, untimely rental payment or outstanding balances owed to another
apartment or rental owner or property manager.

CREDIT HISTORY: Your credit must reflect that all accounts are current. Application for tenancy will be
reviewed if you have filed for bankruptcy, have a credit score below 500 or have collections.

CRIMINAL HISTORY: Your application will be rejected if you have been convicted for any type of crime
that would be considered a serious threat to the rental property, other resident or neighbors.

SMOKING: This is totally no smoking or vaping property. Smoking or vaping inside of the rental property,
inside of other buildings on the property or anywhere on the rental property is grounds for eviction.

PETS: Pets of any kind are not allowed in any rental home or apartment.

RENTAL APPLICATION

NAME: ___________________________________________________ DATE:______________________


JOINT TENANT:________________________________________________________________________

HOME PHONE:_____________________________ CELL PHONE:________________________________

PRESENT ADDRESS:_____________________________________________________________________

HOW LONG AT PRESENT ADDRESS:______________________ LANDLORD:_________________________________

ADDRESS:___________________________________________ PHONE:___________________________

PREVIOUS ADDRESS:______________________________________________ HOW LONG_________________


(If less than 2 years, give all addresses for the last two years. Use back side of application if necessary)

ADDRESS:________________________________________________________________ (________YRS)
OWNER/MANAGER:__________________________________________ PHONE: ___________________

ADDRESS:________________________________________________________________ (________YRS)

OWNER/MANAGER:__________________________________________ PHONE:___________________

ADDRESS:________________________________________________________________ (________YRS)

OWNER/MANAGER:__________________________________________ PHONE:___________________

IF HOME OWNER—LOAN HELD BY:_________________________________________________________

PERSONAL DATA

TENANT INFORMATION:

BIRTHDATE:__________________________ SOCIAL SECURITY NUMBER:__________________________

DRIVERS LICENSE NUMBER:_____________________________ EXP. DATE:________________________

NUMBER OF CHILDREN:_________________ AGES OF CHILDREN:_______________________________


CAR MAKE:_________________ YEAR:_________ MODEL:_________________ COLOR:______________

CAR LICENSE NUMBER/STATE:____________________________________________________________

CO-TENANT INFORMATION:

BIRTHDATE:__________________________ SOCIAL SECURITY NUMBER:__________________________

DRIVERS LICENSE NUMBER:______________________________ EXP. DATE:_______________________


NUMBER OF CHILDREN:_________________ AGES OF CHILDREN:_______________________________

CAR MAKE:_________________ YEAR:___________ MODEL:_________________ COLOR:____________

CAR LICENSE NUMBER/STATE:____________________________________________________________

OCCUPATION

PRESENT *PRIOR CO-TENANT PRESENT


OCCUPATION
EMPLOYER
SELF EMPL DBA
BUSINESS ADDRESS
BUSINESS PHONE
TYPE OF BUSINESS
POSITION HELD
NAME & TITLE OF
SUPERVISORY
HOW LONG
MONTHLY GROSS
INCOME
*If employed or self-employed less than two years, give required information of prior occupation.

BANK REFERENCES/CREDIT/LOAN INFORMATION

CREDIT ADDRESS HIGHEST AMT PUPOSE OF ACCT OPEN OR


REFERENCE OWED CREDIT DATE CLOSED

BANK_________________________________________ SAVINGS ACCT NUMBER___________________

BANK_________________________________________ SAVINGS ACCT NUMBER___________________


PERSONAL REFERENCES (LOCAL PREFERRED)

NAME_____________________________________________________ PHONE____________________
ADDRESS_______________________________________________________________________

NAME_____________________________________________________PHONE_____________________
ADDRESS_______________________________________________________________________

LIST ALL PERSONS WHO PLAN TO OCCUPY THE PROPERTY

NAME BIRTH DATE SOCIAL SECURITY NUMBER

Please indicate the date you would like to move in:______________________________________

Name of person/s to notify in case of an Emergency:

Name:______________________________Relationship:__________________ Phone:_______________

Address:______________________________________________________________________________
OR

Name:______________________________Relationship:___________________Phone:______________

Address:______________________________________________________________________________

Have you ever filed a petition in bankruptcy?_____Have you ever been evicted from any tenancy?_____
Have you ever willfully and intentionally refused to pay any rent when due?_______
Will you have any pets?______ Do you or anyone that plans to occupy the rental with you smoke?_____
Will you have any liquid (water bed, etc.) furniture?_______
I/we agree that the Landlord may terminate any agreement entered into in reliance on any
misstatement made above.

I/we, the under-signed certify that the information given is accurate. I/we give my/our authorization
to the above named landlord to verify any and all information above, including but not limited to
access my credit history through the national credit bureaus and/or my creditors, certify my criminal
background, obtain references from current/past landlords and employers (including income
verification), bank and personal references.

I hold William(Bill) Shaw, Sonya Shaw, SS Land Ties LLC, their owners, employees, their clients, and my
current/past landlords and employers harmless for any information shown on my report and any action
taken based on that information. I understand this report will be sent directly to the landlord named
above and that we cannot receive a copy of this report directly from the above landlord.

I understand that I am entitled to a free copy of this report from the furnisher if I am denied residence
based upon information contained in his report.

Acceptance of deposit and rental agreement is dependent upon verification of above statements.

I DECLARE THE FORGOING TO BE TRUE UNDER PENALTY OF PERJURY

APPLICANT__________________________________________________ DATE_____________________

APPLICANT__________________________________________________ DATE_____________________

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