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Heron Club
2050 Goodpasture Loop
Eugene, OR 97401
(541)334-5100
fax: (541)431-0719
APPLICATION TO RENT
APPLICANTSlast Name
First
Middle
Driver'slicense # and State
Soc. Sec.
IBirthdate
Numberof Total Occupants
Name of Present landlord
What type of pet do you have?
Dno
Dcat
Ibs
Ddog
Dyes
CURRENT RESIDENCE HISTORY
State
City
Zip
rhone #
Telephone #
Howlong?
SECTION 2
APPLICANTSPreviousAddress
PREVIOUS RESIDENCE HISTORY
State
Zip
City
Do you have pets?
SECTION 1
APPLICANTSCurrentAddress
Apt.#
Apt.#
Name of Previous landlord
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To:
From:
,
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Previouslandlord#2 Telephone#
SECTION 3
APPLICANT CurrentEmployment(Sourceof Income)
EMPLOYMENT
Department
Address
State
City
-Previous Employment (Source of Income)
Address
Dother
IpreviouslandlordPhone#
To:
From:
Howlong?
PreviouslandlordTelephone#
Previous Address #2 landlord
APPLICANT
Ibs
Zip
State
City
Howlong?
Phone
MonthlyIncome
$
Supervisor's NameIC.O.
How long?
Phone
Zip
:)
Supervisor's NameIC.O.
IPOSition Held/Occupation
Department
.
,
HISTORY
Monthly Income
rOSitiOn
HeldlOccupatio $
ADDITIONAL INCOME
SOURCE:
Amount of $
, Source
per
SECTION 4
CREDIT AND LOAN REFERENCES
Auto #1 (Make & Model)
lic. Plate
State
Car Payment made to
Auto #2 (Make & Model)
lic. Plate
State
Car Payment made to
Monthly Payment
$
Monthly Payment
$
Other Vehicles (Boats, Vans, Motorcycles, RV's, etc.) Make. Model, license Plate
Total Debt
loans, Charge Accounts, & Credit Cards owed to
Monthly Payment
$
Total Debt
Monthly Payment
$
Checking Account #
Other
Branch
Bank or Savings and loan
SECTION5
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ADDITIONALINFORMATION
Name of APPLICANTS Nearest Relative
Relationship
Address
City
State
Phone
Emergency Contact
Relationship
Address
City
State
Phone
Personal Reference
Relationship
Address
City
State
Phone
.,.'.
Why are you vacating your present place of residence?,
How did you hear about us?(if referred by a friend or relative please include their name and address)
Have you given legal notice to vacate? Dyes
Dno
Have you ever been convicted of a crime? Dyes
Ono
I certify that the above information
is grounds for rejection of the application.
If any information
and mode of living.
I understand
lan(jlord~may
obtain an Investigative
rental history, and may include information
You have the right to request additional disclosures
IHhe application
by the screening
is approved, applicant(s)
will have _hours
consumer report
or false information
Consumer
is
of tenancy.
Report which includes the
as to hislher character, general reputation,
provided for under section 606 of the
Federal Fair Credit Reporting Act, and a written summary of your rights pursuant to Section 609(c).
information provided to the ownerlagent
and scope of the investigation.
that giving incomplete
supplied on this is later found to be false, this is grounds for termination
has charged a screening fee as set forth above.
checking of the applicant's credit, income, employment,
personal characteristics,
Dno
is complete and correct and hereby authorize you to do a credit check, obtain an investigative
and make any inquiries you feel necessary to evaluate my tenancy and credit standing.
OwnerlAgent
Dyes
Have you ever been evicted?
When and where?
You have the right to dispute the accuracy of the
company or the credit bureau as well as a complete and accurate disclosure
of the nature
from the time of notification to either execute a rental agreement and make all
deposits required thereunder or make a deposit to hold the apartment and execute a deposit receipt which will provide for the forfeiture of the deposit
if applicant(s)
fail to occupy the apartment.
If applicants fail to timely take the steps required above, they will be deemed to have refused the a
apartment and the next applicant for the apartment will be processed.
Date:_'_'-
Applicant x.
Manager
Date:_'_'-
x,
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Style of apartl11el1t:
---- 1 Bedrool11
__2
BedroOlll
3 Bedroot11
I>ate apartnlellt
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Heeded:
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Pet Policy:
J
The Heron Club dUI's allow small orllllf/Jcf.r as long iT5thr'.fr)17nWT/I/!
1. On(v
app1'-n:
I pet I:f aIIO1.!Jf'dl'f'r al1<1
rlml'Ilt
llIml hf' adult, lzouJd>ro/.-m, II ,/il/NI to obedieJlt'f'. &: .<tdYI'r//'11>utaed
S. A $3(XJ.(}() lIoll-r'!fimdl/hIf i'd.fP" 11Iwl hI'faid. ReJidl'l11 1f'1111>1'"'S1'11/1(/-"'(',/0l' i'"ying
'-aItJ remllingfrom thf' pet.
.
4. T1zp-pet wil/not bp-allowed to a,'"t, '7(1'_Ul7'elIoiJP-.
5. rl('(llI 1fp .roil 01' mf'-f.f immediatf-'1.r
"/"'rllf',f/~vthepet.
6. Pd 11111.,1
I/(-'keft on /1If't1slzand atll'J/,It'dI1t all times
'2. Tit" f'd
7. Cumf'1.vwith all ci~vor com/f.'>
ordll//ml""<
1'f'gardil1g
any 1'epair or 1'ef.laa'1!/(,//[
j)('tr
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RESERVATION PROCESS
1. A $25.(
,( I 'Inlir'll;. n fre is rP'lui, rd 1° J' r<"I.
Tile "Frlir"lion
If'(' is fer II,,:, "'rr'(:~I'
a.
1,1<nJllt' \'(,'ilicJlioll
b.
('"n"'III
,
I " /11,1.ling till' f.II,\\ilq:
'JI1.I,n'viells l'IIIJlu,1 ,. I." "'"
c. C"./;t ",lilll
d. P.'ropl.-I/IIII'H"r,lr.,lrr:Il, <ell.,1;. '" ., jIl'11I11ell'~
e.
2.
CdJllilnl"
{'I'd
Upon arl"'C\'JI 'f"11\\illl:-e rerll1irr-J In , "I ' 1>K('.(O
res'"
,Ii, " ,', f' ,if.
II 'ICIIcall' .IIInllf' r-ese,valioll I. I. re '!"III'
move-in J,II' ""II" ,I. r"'il \\ ill 1-('J'f,fulI-II,1'1< I, IIf"'~:
25 ,L'I~ 111"""" rdm In rnc"l:-ill
20
--},1 J"I'
6 - r) .1"'1' pi0r In mnv('-in
0 - Ci"""~ pkr- I" lrIo"e-ill
3.
41;1'7'>.('(1nfulI,lei
1!,W >.(f! ,AIII\.ltJ
rd"f' 10 1II0\I'-ill
~ I( '.CO fefulI,Jrci
u_- ( ,( C H fllwl, ,
Reasons f,,1'q (1'lIi,,1 \\ill "" ~e disw,,"1.
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j\"'J illlcn1lrJlil'lI ""11 i' 1111\'rih ,II. , I' f,llsifi.,I \\;1111 calise for a.l, IIhI.
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