APPLICATION CHARGE $35.00
Payment in
CHECK OR MONEY ORDER ONLY
All Fees are Non-refundable
AG CAMPUS HOUSING
1400 High Street Suite C3 Eugene, OR 97401
PHONE (541) 505-9906 FAX (541) 654-5446
Email: Info@agcampushousing.com


Group ID: (Optional):
RENTAL APPLICATION
Address
Unit #
City
State
Zip
Date
Time
Roommates
Rent Per Month
Security Deposit
Carpet Dep.
Pet Dep.
Application Charge
APPLICANT
Phone
Name
E-Mail
Drivers License
State
Social Security #
D.O.B
Employer
Job Title
Employer Address
Employer Phone
Monthly take home
How long
SPOUSE
Phone
Name
E-Mail
Drivers License
State
SSN / Passport #:
D.O.B
Employer
Job Title
Employer Address
Employer Phone
Monthly take home
How long
Present Address
City
State
How long
Current Landlord / Manager
Phone
Former Address
City
State
How long
Former Landlord / Manager
Phone
Children(s) Name / Age: 1. /
2. /
3. /
4. /
Pets
Waterbed?
Piano?
Aquarium?
Make of auto(s)
Year
License
State
Credit References (charge accounts, loans, contract purchases, etc.):
1.)
Balance
Paid Monthly
2.)
Balance
Paid Monthly
Personal References (non-relative, known for more than one year.):
Name
Address
Phone
Name
Address
Phone
Nearest relative
Relationship
Address
Phone
I certify the above information is correct and complete and hereby authorize you to do a credit check, obtain an investigative consumer report and make any other inquiries you feel necessary to evaluate my tenancy and credit standing. I/WE understand that giving incomplete information is grounds for rejection of the application. If any information supplied on this is later found to be false, this is grounds for termination of tenancy.
Owner/Agent has charged a screening fee as set forth above. Landlord may obtain an Investigative Consumer Report which includes the checking of the applicant's credit, income, employment, rental history and may include information as to his/her character, general reputation, personal characteristics and mode of living. You have the right to request additional disclosures provided for under Section 606 1681 d(b) of the federal Fair Credit Reporting Act, and a written summery of your rights pursuant to Section 609(c). You have the right to dispute the accuracy of the information provided to the owner/agent by the screening company or the credit bureau as well as the complete and accurate disclosure of the nature and scope of the investigation. The name and address of the screening service is background Investigations, Inc., 1800 Blankenship Rd., West Linn, OR. 97068.
If the application is approved, applicant(s) will have 24 hours from the time of notification to either execute a rental agreement and make all deposits required hereunder or make deposit to hold the unit and execute a deposit receipt which will provide for the forfeiture of the deposit if applicant(s) fail to occupy the unit. If applicant(s) fail to timely take the steps required above, they will be deemed to have refused the unit and the next applicant for the unit will be processed.
Signatures:
Applicant
Spouse