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A non-refundable Application Fee of $30 is required at the time of the application or
before processing takes place. The application fee must be paid by exact cash, money
order or certified check.
To speed your application process, please supply us with the following:
• All names, addresses and contact information of your current landlord.
• If receiving Social Security Disability or Social Security Payments, a copy of your
award letter from the Social Security Administration.
• Copies of your most recent bank statements.
• Copies of your 4 most recent pay stubs for all adults in household.
Dear Prospective Tenant(s):
Applicants for rental housing are approved upon third party verifications that demonstrate the following:
___ Standards for affordability. (HUD states a family should not exceed one third of their monthly
income for housing needs)
___ Applicant(s) has a minimum of three years favorable housing references.
___ Applicant(s) has favorable personal references
___ Applicant(s) has resided in Tippecanoe County for at least the last twelve (12) months (most properties).
___ Applicant(s) has been employed for at least the last twelve (12) months at the same location (most
properties).
Applications are denied for the following:
___ Recent evictions, within the last three years
___ Criminal history
___ Unsatisfactory housing references
___ Unsatisfactory personal references
___ Ineligibility based on inadequate income or exceeding HOME guidelines
___ Falsified documentation or incomplete application
___ Ownership of unacceptable canine breeds
B.W. Parks Property Management manages rental housing under different state and federal programs. These
programs require our rental staff to verify such information as, but not limited to, student status, material status and
asset income.
Please inquire with our rental staff if you have any questions about the application, selection process or income
guidelines.
Thank you,
B.W. Parks Property Management
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THE UNDERSIGNED IS APPLYING FOR A RENTAL UNIT WITH B.W. PARKS PROPERTY MANAGEMENT
Location Applied For: Date
Date you want to move in? :
Full Name: Date of Birth:
Social Security Number: Marital Status:
Home Phone: Cell Phone:
Employer: Work Phone:
Occupation: Length of employment:
Drivers License # & State Issued by: Gross Monthly Income: $
Email address:
RENTAL REFERENCES (3 MOST CURRENT)
Reference #1 Address: Monthly Rent: $
Current Address Landlord Name: Phone #:
Length of time at address: Dates:
Reference #2 Address: Monthly Rent: $
Previous Address Landlord Name: Phone #:
Length of time at address: Dates:
Reference #3 Address: Monthly Rent: $
Previous Address Landlord Name: Phone #:
Length of time at address: Dates:
CREDIT REFERENCES (bank accounts, credit cards, loans, etc.)
Bank #1 Name of Institution:
Phone #:
Type of Reference:
Bank #2 Name of Institution:
Phone #:
Type of Reference:
Have you ever filed a petition for bankruptcy? No Yes, explain:
Do you have any pets? No Yes, explain:
Have you rented with us before? No Yes, address and date:
Have you ever been evicted? No Yes, explain:
Have you ever willfully and intentionally
refused to pay rent when due? No Yes, address and date:
Application Fee: _____
Paid: ________
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OCCUPANTS - LIST ALL PERSONS TO OCCUPY APARTMENT (IF THERE ARE MORE OCCUPANTS PLEASE LIST THEM ON A
SEPARATE SHEET OF PAPER)
Name:
Occupant Relationship to applicant: Date of Birth:
Social Security Number: Drivers License #:
Name:
Occupant Relationship to applicant: Date of Birth:
Social Security Number: Drivers License #:
Name:
Occupant Relationship to applicant: Date of Birth:
Social Security Number: Drivers License #:
EMERGENCY CONTACT INFORMATION (PERSONS NOT LIVING WITH YOU)
1
st
Contact Name:
Parent/Guardian or Address:
Nearest Relative Relationship: Phone:
2
nd
Contact Name:
Parent/Guardian or Address:
Nearest Relative Relationship: Phone:
PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION:
It is my understanding that this application is preliminary only and involves no obligation of the owner or its agent to
approve this application or to deliver occupancy of the proposed premises. If this application is accepted by the
owner or its agent, the $ deposit tendered herewith will be applied to the lease agreement. If
Lessor approves application, and the applicant is notified, then the applicant has the right to withdraw this
application at the time of notification. If the applicant accepts the proposed premises when notified, then later
rejects occupancy, Lessor retains the right to keep the deposit as liquidated damages. I hereby certify that the
above information is correct and authorize the management to make a thorough credit investigation, including
information as to character, reputation, and financial responsibility. I understand that in signing this application, any
misrepresentation or omission of fact is cause for rejection of my application or termination or any lease agreement
should my application be accepted. I further agree that the Lessor or its agent shall not be liable in any respect, if
my application or lease is cancelled or terminated by reason of the falsity of any statements, answers, or omissions
made by me on this application. Possession shall be subject to vacation of the premises by the prior tenant, if any.
Signature of Applicant: Date:
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LANDLORD REFERENCE CHECK VERIFICATION
To: _____________________ Date: _____________ Address: ________________ _
_____________________ APPLICANT/RESIDENT: ________________________
_____________________ _____________________________________________
TEL#:___________________
FROM:
TEL#:_____________________ FAX#:______________________
I authorize B.W. Parks Property Management, its subsidiaries, or its managing agents to investigate my rental
history. The investigation may include, but is not limited to, the questions below.
______________________________________ _______________________________
Signature Applicant Social Security Number
Dates of residency: From___________ to______________. Total number of months__________
1. Did the resident pay their rent on time? ______________________________________________
If the resident was late on rent, how late and often? ______________________________________
Any NSF? ___________________ Comments__________________________________________
2. How much rent was paid each month by this resident? ___________________________________
3. Did you receive a security deposit? __________________________________________________
How much of it was returned to the resident? __________________________________________
4. Did the resident, their guests, or their family damage the apartment or the property? ___________
Did they pay for the damages? ________________ Amount of damages $___________________
5. Were the police ever called as a result of a disturbance?_________________ Date____________
Comments______________________________________________________________________
6. Were there problems with the neighbors? _____________________________________________
7. Does the resident have pets or other potential problems that may be important for a landlord to know?
_________________________________________________________________________
8. Did the resident violate the lease agreement in any way? _________________________________
Comments______________________________________________________________________
9. Did resident give proper notice for vacating? __________________________________________
Reason for leaving? ______________________________________________________________
10. Is resident eligible for re-rental? ____________________________________________________
11. Housekeeping Skills? _____________________________________________________________
__________________________________________ ___________________________________
Signature and Title of Person Verifying Information Date and Telephone Number
TO BE COMPLETED BY LANDLORD
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RESIDENT RELEASE AND CONSENT
To: ____________________ Date: _____________ Address: _________________
_____________________ APPLICANT/RESIDENT: ____________________
_____________________ ___________________________________________
TEL#:___________________
FROM:
TEL#:_____________________ FAX#:______________________
I/We, the undersigned, hereby authorize all persons or companies in the categories listed below to release without
liability, information regarding employment, income, and/or assets to B.W. Parks Property Management for the
purposes of verifying information and my/our apartment, house or duplex rental application.
INFORMATION COVERED
I/We understand that previous or current information regarding me/us may be needed. Verifications and inquiries
that may be requested, but are not limited to: personal identity, student status, employment, income, assets,
medical or childcare allowances. I/We understand that this authorization cannot be used to obtain any information
about me/us that is not pertinent to my/our eligibility and continued participation as a Qualified Tenant.
GROUPS OR INDIVIDUALS THAT MAY BE ASKED
The groups or individuals that may be asked to release the above information include, but are not limited to:
Past & Present Employers Welfare Agencies Veterans Administrations
Past & Present Landlords State Unemployment Agencies Retirement Systems
Support & Alimony Providers Social Security Administration Banks & Financial Institutions
Credit & Background Check Agencies Educational Institutions
Medical & Child Care Providers
CONDITIONS
I/We agree that a photocopy of this authorization may be used to the purposes stated above. The original of this
authorization is on file and will stay in effect for 6 months from the date signed. I/We understand I/We have the
right to review this file and correct any information that is incorrect.
SIGNATURES
__________________________ _____________________ __________________
APPLICANT Social Security Number Date
________________________ _____________________ __________________
APPLICANT Social Security Number Date
________________________ _____________________ __________________
APPLICANT Social Security Number Date
