3718 East Michigan Street

Indianapolis, IN, 46201

317-357-INDY (4639)

Investment Management, Leasing, Construction, and Maintenance

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Name

First Name

Last Name

Phone Number

(###)

###

####

Date of Birth of Primary Applicant

YYYY

Social Security number

Email Address

Dependents

Please list all dependents and their dates of birth.

Address Interested In (if no particular address, list how many bedrooms and side of town you are interested in)

List all pets

If none, list 'none'

Current Address*

Please include current street address

Current address city

List City

State

Current zip code

Provide the zip code for your current address

Month/year moved-in

Please list the month and year you moved into your current address

Reason for leaving

Please list the reason for leaving your current address

Current rent amount

List your current rent amount

Current owner/agent name

List the current owner/agent's name

Contact number for owner/agent

Please provide a contact number, email or fax for the owner/agent of current residence

Previous address*

Please list full address, month/year moved in, reasons for leaving, rent amount, owner/agent and contact number

Planned Move In Date

YYYY

Number of Occupants (include yourself, all children, and all adults)

Monthly Gross Income (of all adults on lease) ** monthly income must meet 3 times the monthly rent amount

Other notes

Employment/income information

Please indicate your current employment status*

Employer information

Please include your employer, dates employed, job title and salary

Work phone number

Contact number at work

Supervisor's name

Please list supervisor's name.

Supervisor's contact number

(###)

###

####

Additional income information

Please list any additional sources of income you would like us to consider

Expenses

List all credit obligations with minimum payment (car payment, credit cards, cell phone, child support, etc)

Have you declared bankruptcy in the past (7) years?

Have you ever been evicted from a rental residence?

Have you ever had two or more late rental payment in the past year?

Have you ever willfully or intentionally refused to pay rent when due?

Are you or will you be in the future a registered sex offender?

*Note- if you are required at some point in your tenancy to become a registered sex offender, if may be cause for termination of your lease.

Emergency Contact

Name of person not residing with you and relationship

Phone number of emergency contact

Provide phone number of emergency contact

Address of emergency contact

Please provide street address, city and state of emergency contact

Personal Reference 1 (Non-family)

List name, phone number, relationship

Personal Reference 2 (Non-family)

List name, phone number, relationship

Additional information

Acknowlegment of Application Fee

I/We hereby leave this payment as a NON-REFUNDABLE application/administrative fee. This application fee covers all credit and criminal report charges. Such sum should not be considered a rental payment or security deposit. In the event that this application is denied, this sum will be retained by the Owner/Agent to cover the costs incurred for processing this application as furnished by the application. The above information, to the best of my knowledge, is true and correct. I understand that should any statement made above be a misrepresentation or not a true statement of facts, my application will be immediately denied. Please type your name and the date to sign.

AUTHORIZATION- Release of Infomation

I hereby authorize Barron Property Services, LLC to obtain a consumer report, and any other information it deems necessary for the purpose of evaluating my application. I understand that such information may include, but is not limited to, credit history, civil and criminal information, records of arrest, rental history, employment/salary details, vehicle records, licensing records, and/or any other necessary information. I understand that subsequent consumer reports may be obtained and utilized under this authorization in connection with an update, renewal, extension or collection with respect or in connection with the rental or lease of a residence for which application was made. I hereby expressly release Barron Property Services, LLC and any procurer or furnisher of information, from any liability what-so-ever in the use, procurement, or furnishing of such information, and understand that my application information may be provided to various local, state and/or federal government agencies, including without limitation, various law enforcement agencies. **Type your name, Social Security number and the date as authorization*****

Social security number

Type your social security number here

Authorization date

Enter today's date for authorization

YYYY

*Please make sure to hit SUBMIT to send your application before paying below fee to ensure your information does not get lost!*