RENTAL APPLICATION

PG Rentals at RE/MAX of Boulder..........................................Date ____________________
2425 Canyon Blvd, #110
Boulder, CO 80302
Phone 303.564.4762
FAX 303.442.2998

BLACK INK ONLY, PLEASE.

Include a check for $40 (application fee), made out to Premesys Group (no cash), and a photocopy of your driver’s license. Application cannot be processed without these two items. APPLICATION MUST BE COMPLETED IN FULL.

Property Address ___________________________________________ Unit________

Rent Amount: $________ Anticipated Move-In Date___________ Lease term______

Name of Applicant: _______________________________ Date of Birth ___________

Social Security # ___________________ Driver’s License #_____________ State _____

Are you a student? ___Yes ___No * If you are a student, you may be required to have a co-signer.

Phone numbers where you can be reached _____________________________________

E-mail address___________________________________________________________

Pets: ___none, ___cat, ___dog, ___other _____________________________

Names of other occupants: Relationship: Also filling out application?

_____________________________ ____________________ ___ yes ___no
_____________________________ ____________________ ___ yes ___no
_____________________________ ____________________ ___ yes ___no

1. Are you a smoker? ___yes ___ no
2. Have you ever been evicted from any tenancy? ___yes ___no
3. Have you ever filed a petition of bankruptcy? ___ yes ___ no
4. When this lease expires, do you plan to: ___lease, ___buy, ___don’t know
5. Social Organizations? (Please list) ________________________________________

==============================================================================

PERSONAL REFERENCES (non-related except emergency reference; one local):

Name & Address ______________________________________________ Phone _________________

Name & Address ______________________________________________ Phone _________________

In case of emergency, notify:_____________________________________ Phone _________________

Address (city, state, zip) ____________________________________________________

Relationship ____________________________________

RENTAL HISTORY
Present Address: ________________________ City, State, Zip: ___________________
Phone: (h)______________ (w) _____________ Monthly: ___rent, ____ mortgage $_____________
Landlord’s name: _______________________ Landlord’s phone: __________________
Move-in date: _________ Move out date: ___________ Notice to vacate given? ___yes ____no
Reason for moving: _______________________________________________________
Breaking your lease? ___yes ___no If yes, state reason: ____________________________

Previous Address:________________________ City, State, Zip: __________________
Landlord’s name: ________________________ Landlord’s phone: _________________
Move-in date: ________ Move out date: ________ Reason for moving ____________________
Monthly ____ rent, ____ mortgage $___________

EMPLOYMENT HISTORY
Present Employer: __________________________________ Position _______________
Address:______________________________ City, State, Zip _____________________
Monthly salary (gross): $_________ How long employed: From: ________ To: _______
Personnel Dept. name & phone (to verify employment) ___________________________

Previous Employer: _______________________________ Position _______________
Address: ______________________________ City, State, Zip _____________________
Monthly salary (gross) $ ________ How long employed: From: ________ To: ________
Personnel Dept. name & phone (to verify employment): __________________________
Other source of income or assets you wish us to consider _________________________
Contact for verification ____________________________________________________

FINANCIAL INFORMATION
Bank: ___________________ Branch: ________________ Phone: ________________
Checking acct # ________________________ Savings acct # _____________________
Other accounts: __________________________________________________________
Other Financial Obligations: ________________________________________________
________________________________________________________________________
Are there any outstanding judgments against applicant? ___________________________

AUTOMOBILES
Make: _________ Model: _________ Year: _____ Color: ________ License:_________
Make: _________ Model: _________ Year: _____ Color: ________ License:_________

I/We authorize PG Rentals at RE/MAX of Boulder LLC to obtain information to verify the statements made in the application and in addition, acquire a credit history and public records of any unlawful activity. I also authorize Premesys Group LLC to acquire a credit history to be used if the rental unit requires Renter’s Insurance. I/We further agree that the application shall remain with PG Rentals at RE/MAX of Boulder and may also be shared with the property owner. I/We certify that all statements in this application are true and complete and are made for the purpose of renting property.

I understand that any false answers or statements made by me will be sufficient grounds for
eviction and loss of any security deposits. Failure to fully complete this application will
cause a delay or denial in processing. I understand that if I do not live up the terms of the
lease, or fail to pay the rent, information may be turned over to a credit-reporting agency.

_________________________________________ _______________________
Applicant signature and Date