First Name:_________________ Middle Initial:_____ Last Name:__________________
SS #: ______________   Driver's License #: ______________________ State:_______
Telephone #: ___________________      Cell #: ________________________ 

Present Street Address: _______________________________________________
Present City & State: __________________________________________________  
Present Landlord’s Name & Telephone #:_________________________________
How Long Have You Resided There? ______________________________________
Reason for Leaving: ____________________________________________________ 

Previous Street Address:_________________________________________________
Previous City & State: __________________________________________________  
Previous Landlord’s Name & Telephone #:_________________________________
How Long Did You Reside There? _________________________________________
Reason for Leaving: ____________________________________________________  

Marital Status: ___Single ___Married __ Separated ___Divorced ___Widowed
Spouse's Name (If Married or Separated): _________________________________ 
Children:  ____ YES ____ NO                                              How Many? __________   
Names & Ages: ______________________________________________________ 
Pets:  ___YES ___NO       What Kind?  ___________________ How Many? ______
 

Applying For: __________________________________________________________
Desired Bedrooms: ____________    Desired Bathrooms: ________________   
 

YOUR EMPLOYMENT
Employer: __________________________________________
Employer Address: _________________________________
Telephone #: ______________________________
Date of Hire:  _________________
Monthly Income: ___________________________
Other Income:  ____________________________ 

SPOUSE'S EMPLOYMENT
Employer: ________________________________
Employer Address: ________________________
Telephone #: ______________________________
Date of Hire:  _________________
Monthly Income: ___________________________
Other Income: ______________________________ 

REFERENCES
Banking Institution: ____________________________ Telephone #:_____________
Personal Reference: ____________________________ Telephone #: ____________
Credit Reference: ______________________________ Telephone #: ____________
Credit Reference: ______________________________ Telephone #:___________              

Applicant authorizes Landlord to verify the foregoing information and to make credit, employment, rental history, and reference inquiries deemed necessary by them, and Applicant also authorizes the release of information contained on this application or sought by such inquiries. If this application is accepted by Landlord, Applicant agrees to execute a rental agreement of the Property in the form which has been exhibited to Applicant by Landlord, and agrees to pay the rental for one month and a security deposit before occupation of the Property. Applicant agrees that the Property Manager or Real Estate Broker representing the tenant or Landlord and all affiliated agents are not responsible for obtaining or disclosing any information contained in the South Carolina Sex Offender Registry.  The Applicant agrees that no course of action may be brought against the Property Manager or Real Estate Broker representing Tenant or Landlord and all affiliated agents for failure to obtain or disclose any information contained in the South Carolina Sex Offender Registry.  The Applicant agrees that the Applicant has the sole responsibility to obtain any such information.  The Applicant understands that Sex Offender Registry information may be obtained from the local sheriff’s department or other appropriate law enforcement officials.

Applicant agrees the information provided in this application is true and accurate.  If any information is found to be false or misleading, the application may be denied. 

__________________________________       _______________________________
Signature of Applicant                                       Signature of Applicant  

____________________________________
Signature of Owner/Property Manager