Clearbrook Management, Inc.

RENTAL APPLICATION
Application Fee: $25 per adult and $40 per family
All prospective tenants age 18 and older must complete this application.
Property Address: ________________________________________________________________________________________
Applicants Name: ________________________________________________________________ Date of Birth: ____________
Phone #: _____________________________

Email address: ____________________________________________________

Social Security #: ____________________________________

Drivers License #: ____________________________________

Present Address: _________________________________________________________________________________________

How long at this address? ______________________________ Monthly Rent/Mortgage: $____________________________
Landlords Name: _____________________________________ Phone Number: _____________________________________
Reason for leaving: _______________________________________________________________________________________
Previous Address: _________________________________________________________________________________________
How long at this address? ______________________________ Monthly Rent/Mortgage: $____________________________
Landlords Name: _____________________________________ Phone Number: _____________________________________
Reason for leaving? ________________________________________________________________________________

Who will be living with you:

Name

Age

Relationship

_________________________________

_______

_____________________

_________________________________

_______

_____________________

_________________________________

_______

_____________________

Current Employer: ___________________________

Address: ____________________________________________

Employer Phone #: __________________________

Supervisors Name: ____________________________________

How long with this employer? __________________

Gross income per month (before deductions): $_______________

Other Income: (gross per month) $______________

Source (Pension,SS, etc.) ________________________________

Previous Employer: __________________________

Address: ____________________________________________

Employer Phone #: __________________________

Supervisors Name: ____________________________________

How long with this employer? __________________

Reason for leaving: ____________________________________

OPTIONAL If you receive alimony and/or child support payments and want to have this considered as income for the purpose
of the rental application, provide the requested information below:
Do you receive alimony or child support: ___________ (yes or no)

Amount received per month $__________________

Clearbrook Management, Inc. - PO Box 571 - Colfax, NC 27235 - 336-669-2541 (phone) - 866-759-4390 (fax)

Clearbrook Management, Inc.

RENTAL APPLICATION
Do you have a bank account? ____________ (yes or no)

Name of Bank: __________________________________________

Have you ever filed bankruptcy? _________ (yes or no)

Have you ever been evicted? _________ (yes or no)

Have you or anyone that will live at this property ever been convicted of a felony? _________ (yes or no)
If yes to any of the above three questions, please explain: ________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

Emergency Contact Person: ________________________________________________________________________________

Address: ____________________________________________________

Phone #: _________________________________

I declare that the information provided above is true and correct. I hereby authorize Clearbrook Management, Inc. (Landlord) or
its agents to verify all information, to get credit reports and background checks on me and any tenant age 15 or older. If a lease
is granted and information provided herein is later determined to be false, it shall be considered a breach of the contract and
the lease can be immediately terminated at the option of Landlord or its agents.
I understand that a non-refundable $25.00 application fee is required to process this application ($40 if multiple applications
from the same family).
Applicants Signature: ____________________________________________________ Date: ________________________

Please return this completed application along with the following to initiate the application process:
Copy of Drivers License
Proof of Income One of the following is required:
o last two pay stubs
o letter of employment from new employer
o copies of last three bank statements (complete copies, not just 1st page)
$25.00 ($40 for families) cash or certified check payable to Clearbrook Management, Inc.
A receipt will be issued.
For Office Use Only
Received by: _______________________________________

Date completed application received: ___________________

Credit completed: __________________________________

Background completed: ______________________________

Landlord referral: _______________________________________________________________________________________

Income verified: ___________________________________

Co-signer required? _____________ (yes or no)

Comments: ____________________________________________________________________________________________
Circle One: Approved / Not Approved

By: __________________________________

Date: _________________________

Clearbrook Management, Inc. - PO Box 571 - Colfax, NC 27235 - 336-669-2541 (phone) - 866-759-4390 (fax)