Occupation:

Supervisor’s Name:

Phone Number:

Salary:

Employer Address:

Current Employer:

Time at Employer:MonthsYears

Employment

Current Address:Street Address City State Zip Code

Previous Address:Street Address City State Zip Code

*(If Current Address is less than 2 years Complete the Previous Address Section Below)*

Current Landlord:

Previous Landlord:

Landlord Phone:

Phone Number:

Rent Amount:

Rent Amount:

Reason for Moving:

Reason for Moving:

*Time at Address:MonthsYears

Time at Address:MonthsYears

Personal Residence

First MiddleFull Name:

Last

Email Address: Home Phone:

Driver License No:

S.S.N:

Date of Birth:

Other Phone:Cell Phone:

State:

Are you in the Military Service? Do any of the Occupants Smoke?

Applicant Information

For Property Address:

All Parties (Co-Signers included) intending to sign a lease agreement for this property MUST fill out an Application.

Is there a Co-Applicant and / or Co-Signer to be attached with this Application?

Name of Co-Applicant and/or Co-Signer to be attached to this application:

Lakeshore Development Company256 Raceway Dr, Suite 12

Mooresville, NC 28117

APPLICATION FOR RENTALS8226 NC-150, Terrell, NC 286821862 Molly’s Backbone, Sherrills Ford, NC 286731659 Molly’s Backbone, Sherrills Ford, NC 286731761 Jacobs Way, Mooresville, NC 28117126 Purple Finch, Mooresville, NC 28117525 N. Miller Avenue, Statesville, NC 286771447 Church Street, Statesville, NC 286771009 Randolph Street, Statesville, NC 28677808 Wilmington Avenue, Statesville, NC 28677720 Wilmington Avenue, Statesville, NC 28677714 Wilmington Avenue, Statesville, NC 286771308 5th Street, Statesville, NC 286771306 5th Street, Statesville, NC 286771302 5th Street, Statesville, NC 286771222 5th Street, Statesville, NC 28677610 C Davie Avenue, Statesville, NC 28677610 B Davie Avenue, Statesville, NC 28677610 A Davie Avenue, Statesville, NC 28677603 Davie Avenue, Statesville, NC 28677601 Davie Avenue, Statesville, NC 28677332 Brevard Street, Statesville, NC 28677381 Euclid Avenue, Statesville, NC 28677377 Euclid Avenue, Statesville, NC 28677399 Westwood Drive, Statesville, NC 28677385 Westwood Drive, Statesville, NC 28677362 Westwood Drive, Statesville, NC 28677337 Westwood Drive, Statesville, NC 28677327 Westwood Drive, Statesville, NC 28677325 Westwood Drive, Statesville, NC 28677319 Westwood Drive, Statesville, NC 28677309 Westwood Drive, Statesville, NC 28677

For Office Only Date/Time Rec’d: Desired Move-in Date: Rent:

Approved Denied

Jon Grigorian704-696-2200Jon@LakeshoreRealty.orgFax: 704-696-2400

Contact Address: Relationship:

Contact Name: Contact Phone:

Emergency Contact

Name:

Name:

Name:

Name:

Name:

Name:

Age:

Age:

Age:

Age:

Age:

Age:

Relationship:

Relationship:

Relationship:

Relationship:

Relationship:

Relationship:

List all name(s), age(s), and relationship of all persons living in the premises with you including children:Anyone living in the property over the age of 18 will be required to fill out an application.

List ALL Pets (Number, Type, & Breed):

Occupants & Pets

Year: Make: Model: Color: Plate:

Year: Make: Model: Color: Plate:

Year: Make: Model: Color: Plate:

Automobiles

Does the Applicant have an Account at a bank?

Bank Name: Bank Phone Number:

Accounts Established:

Bank Information

Name:

Name:

Name:

Phone:

Phone:

Phone:

Relationship:

Relationship:

Relationship:

References (Please list 3)

The undersigned specifically acknowledge(s) and agree(s) that verification of any information contained in theapplication may be made at any time by the Landlord, its agents, successors and assigns, either directly or through a credit report-ing agency, from any source named in this application. Applicant consents to Landlord submitting any information to a Landlord Verification Service Online or otherwise. It is also hereby agreed that the original copy of this application will be retained securely

by the landlord even if the application is not approved.

I, the undersigned, certify that the information given herein is for the use of this landlord and is true to the best of my knowledge.

Applicant Signature:

Printed Name: Date:

Acknowledgement & Agreement

Additional Information