Rental Application – Genesis Opportunity

Applicant Details

Your Full Name (First Middle Last) *

Telephone Number *

Your Current Address *

State ID or Drivers License # *

State of Issue *

Date of Birth *

SSN *

Your Email (required) *

How long at current address? *

Why are you moving? *

Current Landlord Name *

Current Landlord Phone *

Ever been Convicted of a Misdemeanor or Felony? *

No
Yes

If 'Yes', Describe

List whatever charges there were and disposition (what was the end result?)

Are you a Veteran?

Yes
No

If 'Yes', What Branch?

Rental History

Previous Address

Previous Landlord Name

Previous Landlord Phone

How long at the previous address?

Ever been Evicted?

No
Yes

If 'Yes', Describe

Rental Preferences

Other Adult Occupants? *

No
Yes

If Yes, each person over 18 must complete a separate application.

How many?

Any Children? *

No
Yes

How Many? *

Pets? *

No
Yes

If 'Yes', what kind?

How Many Vehicles?

How many registered motor vehicles will be parked regularly at the property?

Employment & Income Sources

Primary Bank Name

Types of Accounts

Checking
Savings
Credit Card (Not Debit)

Check all that you have with your bank.

Ever Filed for Bankruptcy? *

No
Yes

Only if within the last 10-years

If 'Yes', provide Type and Date Filed

Current Employer Name *

Company or if Retired or Disabled, so state

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Your Occupation or Title

How Long?

Gross Monthly Income *

Manager/Supervisor Name

Manager Phone

Other Income Source

Amount per Month

Previous Employment

Only required if Current Employment is Less than 2-Years.

Previous Employer Name

Previous Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Occupation or Title

How Long?

Gross Monthly Income

Previous Manager/Supervisor Name

Previous Manager Phone

Personal References

3-Required / At least 2 cannot be family

Full Name *

Relationship *

Phone *

Email

Full Name *

Relationship *

Phone *

Email

Full Name

Relationship *

Phone *

Email

Emergency Contact

Emergency Contact Name *

Relationship *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone *

File Upload *

Click or drag a file to this area to upload.

Upload an image of your State Issued Identification

Application Processing & Payment

Application Fee *

Price: $ 50.00

Applicant Certification: By signing and submitting this form and paying the Application Fee, I hereby certify that I am at least 18 years of age as the Applicant completing this form. I certify that all information given on this application is true and correct. I hereby authorize verification of all references and facts, including but not limited to current and previous landlords, employers, and personal references. I hereby authorize any owner/agent utilized or authorized by Genesis Opportunity Corporation to obtain any and all Unlawful Detainer, Credit Reports, Telechecks, and/or Criminal Background Reports. I agree to furnish additional credit and/or personal references upon request. I understand that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denial of tenancy. I acknowledge that the Application Fee is not an offer or guarantee of residency and is not refundable. I hereby waive any claim and releases from liability any person providing or obtaining said verification or additional information.

Signature *

Sign Here using your mouse or finger if touchscreen

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Total

$ 0.00