S

Name (Mr./Ms.)______________________________________________ Phone Number (______)_________________

Social Security Number___________________________________ Date of Birth_______________________________

Driver’s License Number (if different from SSN)_________________________________

Marital Status ?Married ?Separated ?Widowed ?Divorced ?Single How long?______________________

Reason for Moving (check as many as apply):

?Getting married ?Getting divorced or separated ?Nicer apartment ?Lower rent ?Living at home

?Roommate moved ?Job transfer ?Moving from another area ?Other (please state)________________________

Present address_________________________________________ ZIP code____________ How long?_____________

Landlord’s name___________________________________ Phone (_____)___________ Rent____________?wk?mo

Previous address How long?_________________________

Landlord’s name Phone (_____)___________ Rent_________?wk?mo

CHARACTER REFERENCES (other than spouse)

( )

Name Relation Address Phone

( )

Name Relation Address Phone

EMERGENCY CONTACT (different from above)

Name Relation Address Phone

BANK REFERENCES

Bank name___________________________________________ Checking Account Number______________________

Address______________________________________________ Savings Account Number______________________

Is your paycheck currently being garnished for any reason, including child support? ?Yes?No Indicate amount_______

AUTO

Year Make License Number Monthly Payment Balance Bank & Acct.#

I, ___________________________________, agree to rent Apartment Number__________ at____________________

_____________________________for $______________per month/week and follow all house rules. I understand that any false statements made herein can subject me to full prosecution under the law. I hereby give S.F. Shannon Real

Estate Management, LLC, permission to check my credit for purposes of approving or rejecting this rental application.

Signed:______________________________________________________ Date:_______________________________

LEAD WARNING STATEMENT

The apartment that I wish to rent was constructed prior to 1978 and therefore may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not taken care of properly. Lead exposure is especially harmful to young children and pregnant women. If I am renting any apartment larger than a “zero-bedroom” apartment, I hereby acknowledge receipt of an EPA pamphlet concerning lead paint poisoning prevention.

I HAVE READ AND I FULLY UNDERSTAND the above disclosure.

Signed: _______________________________________________________Date:______________________________

Employed by___________________________________ Position_______________________ How long?___________

Address________________________________________ ZIP code__________ Phone(______)__________________

Supervisor_________________________________ Phone(_____)_____________ Salary____________?hr?wk?mo

Previous employer______________________________ Position_______________________ How long?____________

Address________________________________________ ZIP code__________ Phone(_______)__________________

Supervisor_________________________________ Phone(_____)_____________ Salary____________?hr?wk?mo

Other income: Source__________________________________________________ Amount _____________?wk?mo

(If applicable) Caseworker and Agency_____________________________________ Phone(_____)________________

THE FOLLOWING PEOPLE AND NO OTHERS ARE ALLOWED TO OCCUPY THE APARTMENT:

Name/Birth date__________________________________ Name/Birth date___________________________________

Children (Names/Birth dates)________________________________________________________________________

PETS (Not permitted unless specified and approved by owner or manager)

Type of pet and name______________________________________________________________________________

I UNDERSTAND that all the above listed people must also follow all the house rules. I also understand that any company I (or we) have must also follow the same house rules.

I UNDERSTAND that my rent is due on the FIRST of each month if I pay monthly, or on FRIDAY if I pay weekly.

If my rent is past due and not paid by the ________th of the month, I understand that I will be charged a late charge of $________________ per month.

If I pay by the week, I understand that if I do not pay by Monday following the Friday that my rent is due, I will be

assessed a $5.00 late charge for each week that my rent is late.

I UNDERSTAND that if anyone moves into the apartment without first obtaining the WRITTEN CONSENT of the owners or their management, my rent will be increased automatically by the sum of $500 per month per person.

Signed: _______________________________________________________Date:______________________________

SECURITY DEPOSIT AGREEMENT

You have paid a security deposit of $_______________ upon moving into this apartment. This deposit is NOT advance rent. Your deposit will be returned in full to you upon moving, provided that you present your receipt for the security deposit and that the following conditions have been met:

1. Rent and any late charges must be paid up to date.

2. Apartment must be thoroughly cleaned. This includes cleaning all appliances and the bathroom and carpeting, if there is carpeting. Apartment must not be damaged. ALL TRASH MUST BE REMOVED FROM THE APARTMENT.

3. Keys must be returned promptly.

If the resident fails to leave the apartment in move-in condition, reasonable charges to complete the cleaning and/or repairs shall be deducted from the security deposit.

You have NOT entered into a lease for this apartment. You must give us at least one month’s notice prior to moving, as required by law.

Should you remain in your apartment LESS THAN ONE YEAR, the owners will deduct ALL of your security deposit.

I UNDERSTAND AND AGREE TO THE ABOVE CONDITIONS.

Signed: _______________________________________________________Date:______________________________

AIR CONDITIONER AGREEMENT

(where applicable)

I understand that if I wish to have an air conditioner in my apartment, I either must bring my own window air conditioner or, if possible, rent one from the owners of the property. I must pay a “user fee” for EACH MONTH that I run the air conditioner or, if I rent a unit from the owners, a combination “rental fee and user fee.” I understand that this user fee helps defray the enormous cost of running the air conditioner. If I use an air conditioner, I agree to pay the user fee or, where applicable, the rental and user fee each month as necessary. The fee also may be paid on a seasonal basis. In some cases, the rental of the air conditioner and user fee may be factored into the monthly rent on a year-round basis.

If I run the air conditioner without paying the user fee or, where applicable, the rental fee and user fee, I hereby grant the owners or their management permission to shut off the electric to my unit and/or remove the air conditioner from my apartment.

Signed: _______________________________________________________ Date: ___________________

HOUSE RULES

?All maintenance requests must be reported to the main office immediately.

?Your apartment must have a working smoke detector. It is YOUR responsibility to keep a working 9-volt battery in your smoke detector.

?You must keep your apartment clean. Trash must be disposed of regularly and in the proper places.

?We hire a professional contractor to provide extermination services. You must allow management regular access to your apartment to accompany the exterminator. We will inform you, within reason, of the extermination schedule for your apartment, but we will not call you each time that the exterminator is due to come.

?St. Louis city code requires that apartments be heated to 65 degrees Fahrenheit during heating season. If you require a temperature much in excess of that required by code, you may not be happy in this apartment.

?If you lock yourself out of your apartment, there is a mandatory let-in fee. Here is the schedule of charges:

$15.00 on weekdays between the hours of 8 a.m. and 7 p.m.;

$25.00 on Saturday or Sunday between the hours of 8 a.m. and 7 p.m.;

$25.00 between the hours of 7 p.m. and 10 p.m.; and

$50.00 between the hours of 10 p.m. and 8 a.m.

?Excessive noise is NOT ALLOWED at any time.

?You are responsible for your behavior and for the behavior of your company.

?Excessive numbers of visitors are not allowed.

?Drinking, loitering and littering in public areas are STRICTLY PROHIBITED.

?Never admit anyone to the building who is not your visitor.

?No illegal drugs or any other illegal activity are allowed in or around the building.

?NEVER, NEVER waste water! Sewer bills are tied to water use. Wasted water on your part may result in an increase in your rent. No washers, dryers or automatic dishwashers are allowed in any apartment.

I HAVE READ the above house rules and I understand them fully. I AGREE that if I violate any of these house rules, I cannot remain in my apartment and I will vacate the building immediately.

Signed: _______________________________________________________Date:______________________________