RON WARD PROPERTIES APPLICATION FORM FORM NUMBER-4/20/2010 Address Inquiring about: 1] NAME PHONE NO. LAST FIRST MIDDLE INITIAL D.O.B. 2] PRESENT ADDRESSHOW LONG CITY STATE ZIP 3] CURRENT LANDLORD PH # PREVIOUS LANDLORD IF LESS THAN 1 YR PH # 4] AMOUNT OF YOUR CURRENT RENT OR MORTGAGE PAYMENT $ 5] S/S NO. DRIVERS LICENSE NO. 6] BANK ACCOUNT NO. 7] EMPLOYER PH# WAGES $ 8] PERSONAL REFERENCES: NAME RELATIONSHIP PH# NAME RELATIONSHIP PH# NAME RELATIONSHIP PH# 9] LIST ALL VEHICLES TO BE PARKED ON PREMISES: VEHICLE YEAR MAKE LICENSE # VEHICLE YEAR MAKE LICENSE # 10] LIST PETS [AND SIZE] IF ANY 11] WHY ARE YOU LEAVING PRESENT RESIDENCE? 12] HAVE YOU EVER BEEN EVICTED? IF YES WHY? 13] DO YOU OR ANYONE TO LIVE AT PREMISES HAVE A CRIMINAL RECORD? APPLICANT REPRESENTS THAT ALL OF THE ABOVE INFORMATION IS TRUE AND COMPLETE AND HEREBY AUTHORIZES VERIFICATION OF ABOVE INFORMATION, REFERENCES, AND CREDIT RECORDS: RWP ANY CREDIT BUREAU ARE HEREBY AUTHORIZED TO MAKE ANY INVESTIGATION OF MY PERSONAL HISTORY, FINANCIAL AND CREDIT RECORDS THROUGH ANY INVESTIGATION OR CREDIT AGENCIES OR BUREAUS OF YOUR CHOICE: ALSO ACKNOWLEDGING THAT FALSE INFORMATION HEREIN MAY CONSTITUTE A CRIMINAL OFFENCE UNDER THE LAWS OF THIS STATE. FUTHER, APPLICANT UNDERSTANDS THAT FALSE STATEMENTS FOUND HERIN MAY RENDER ANY FUTURE RENTAL AGREEMENT NULL & VOID. SIGNATURE OF APPLICANT PRINT NAME & DATE SIGNATURE OF CO-SIGNER [IF REQUIRED] PRINT NAME & DATE