Dash With The Cash Rental Application $25 Application Fee Each Adult
1063 S. 43rd St
Email address *
First Name Adult#1 *
MI Name Adult #1
Last Name Adult #1 *
Age *
Date of Birth *
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SS# Adult #1 *
Phone# Adult#1 *
Additional Phone# Adult#1
Current Address Adult #1 *
City, State, Zip Code Adult #1 *
REFERENCES: Property Owner/Manager Name *
Property Owner/Manager Phone *
Property Owner/Manager Address *
Monthly Rent *
Date You Moved In *
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DD
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YYYY
Current Employer Adult #1 *
Employer Phone *
Employer Address *
Hire Date *
MM
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DD
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YYYY
Supervisor Name *
Hours Worked Weekly *
Gross Monthly Income *
Other Source of Income #1
Other Source # 1 Amt Monthly
Other Source of Income #2
Other Source #2 Amt Monthly
First Name Adult#2
MI Name Adult #2
Last Name Adult #2
Age
Date of Birth
MM
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DD
/
YYYY
SS# Adult #2
Phone# Adult#2
Email Address
Current Address Adult #2 (if different)
City, State, Zip Code (if different)
Owner/Manager Address (if different)
Monthly Rent (if different)
Date You Moved In (if different)
MM
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DD
/
YYYY
Current Employer Adult#2
Employer Phone
Employer Address
Hire Date
MM
/
DD
/
YYYY
Supervisor Name
Hours Worked Weekly
Gross Monthly Income
Other Source of Income #1
Other Source # 1 Amt Monthly
Emergency Contact Person Name & Address
The following people will live with me
Credit Reference Lender #1
Purpose of Loan
Loan Balance Amt
Monthly payment
Credit Reference Lender #2
Purpose of Loan
Loan Balance Amt
Monthly payment
Credit Card/Name on Card
Balance
Monthly Payment
Credit Card/Name on Card
Balance
Monthly Payment
Checking Acct Bank Name
Account #
Savings Acct Bank Name
Acct#
Do you presently own Real Estate ?
Clear selection
If Yes Where?
List Make/Model/Yr/plate# of all vehicles
Requested Move in Date
MM
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DD
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Back Ground Check Agreement
This agreement made this date between NDSI Industries: Owner/Manager” and the below signed hereinafter “Applicant”. The Applicant shall pay to the Owner/Manager nonrefundable fee upon the execution of this agreement in the amount of Twenty-Five Dollars ($25.00). Applicant authorizes the Owner/Manager, his employees, agents, or representatives to make any and all inquiries necessary to verify the information provided by the Applicant herein, including but not limited to direct contact with Applicant's employer(s), landlord(s), credit, neighbors, police, and any Government agencies. The Applicant represents to the Owner/Manager that all the information provided herein tis not as represented, the Applicant may, at the Owner/Manager’s sole discretion, be disqualified. Owner/Manager is not consequential by reason of verification by Owner/Manager, his agents, employees an representativesfrom any and all action, causes of action of any kin or nature that may arise by virtue of the execution or implementation of the agreement provided therein. This property requires a Security Deposit equivalent to one month’s rent minimum that must be paid in full before any rental agreement is made. Applicant acknowledges that, in consideration for the deposit when paid; Owner/Manager is removing the property out of the rental market (i.e. Owner/Manager will not show the property to other interested Applicant(s), upon receipt of the deposit payable to Owner/Manager.

With any signature below, I give NDSI Industries, the authority to run my credit report and criminal background check..

ByI Accepting Below, I Agree To The Terms Listed Above:

ACCEPTANCE OF AGREEMENT *
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