INTERSTATE REALTY

Renter/Buyer Application

GENERAL INFORMATION Property address:_____________________________ Date of desired occupancy______________________

PRIMARY APPLICANT

Last                     First                Middle ________________________________

Social Security # ______________

Birthdate (MM/DD/YYYY) ___________________

Home Address (Number, Street City, State, Zip) __________________________________________________

E. Mail ________________________

Phone - Daytime _____________

Phone - Evening _______________

Phone - Mobile _____________

Married Status Single___Married___Divorced___Widowed___

Drivers License # ______________

State ____

Self Employed? Yes___No___

Current Employer - Name, Address: __________________________________________

How long there ____________

Job title ___________

Monthly salary ___________

Other income ____________

Other income source __________________

Annual income ____________

How is your credit? Good__Bad__Ugly__

CO-APPLICANT

Last                       First               Middle _________________________________

Social Security # ______________

Birthdate (MMJ/DD/YYYY) ____________________

Home Address (Number, Street, City, State, Zip) _____________________________________________

E.Mail _____________________________

Phone - Daytime _____________

Phone - Evening _____________

Phone - Mobile ____________

Marital Status Single___Married___Divorced___Widowed___

Drivers License# _____________

State ____

Self Employed Yes___No___

Current Employer - Name, Address _________________________________________

How long there ____________

Jobe Title __________

Monthly salary ___________

Other income ___________

Other income source __________________

Annual income ____________

How is your credit? Good__Bad__Ugly__

APPLICANT'S MONTHLY EXPENSES Rent___________________________ Mortgage_______________________ Auto Loan_______________________ Auto Insurance___________________ Credit Cards_____________________ Utilities_________________________ Alimony________________________ Child Support____________________ Other Expenses__________________ Grand Total_____________________

PRIMARY APPLICANT ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________

CO-APPLICANT ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________

LANDLORD REFERENCES PRIMARY APPLICANT Name, address, phone # of current landlord __________________________________ __________________________________ __________________________________ CO-APPLICANT Name, address, phone # of current landlord __________________________________ __________________________________ __________________________________

DECLARATIONS Declaration:   1.  Are there any outstanding judgements against you? 2.  Have you declared bankruptcy within the past 7 years? 3.  Have you had property foreclosed upon or given title or deed in lieu thereof in the past 7 years? 4.  Have you directly been obliged on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure or judgement? 5.  Are you presently deliquent on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? 6.  Are you obliged to pay alimony, child support, or separate maintenance? 7.  Is any part of down payment borrowed? 8.  Are you a U.S. citizen? 9.  Are you a permanent legal alien? 10. Do you intend to occupy the property as your primary residence? 11. Have you had ownership interest in a property in the last 3 years as: a. Principal residence(PR) b. Second home(SH) c. or Investment property(IP). 12. How did you hold title to the home: a. Solely by yourself (S), b. Jointly with your spouse ( SP), c. or Jointly with other person(O) 13. Have you ever been asked to leave a rental property? 14. Have you ever broken a rental agreement? 15. Have you ever skipped/missed a rental payment? 16. Have you ever been evicted?  Primary Applicant:         Yes        No Yes        No Yes        No   Yes        No   Yes        No   Yes        No Yes        No Yes        No Yes        No Yes        No Yes        No PR   SH   IP   S    SP    O   Yes       No Yes       No Yes       No Yes       No         Co-Applicant:       Yes       No Yes       No Yes       No   Yes       No   Yes       No   Yes       No Yes       No Yes       No Yes       No Yes       No Yes       No PR  SH   IP   S    SP   O   Yes      No Yes      No Yes      No Yes      No

Certification I declare that the application is complete, true, and correct.  I hereby give my permission for anyone contacted to release the credit or personal information of the undersigned applicant to Management or their authorized agents, at any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended.  I further authorize Management or their authorized agents to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlors, employers and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement entered into with Management.  Any false information will constitute grounds for rejection of this application.  Management may at any time immediately terminate any agreement entered into in reliance upon misinformation given on the application.

Primary applicant's signature: _______________________

Date: ________

Co-applicant's signature: ___________________

Date: _________