ALICE HENDERSON REALTY & RENTALS LLC

166 NORTH GAY STREET

AUBURN ALABAMA 36830

(334) 502-7800 • FAX (334) 502-7802

RENTAL APPLICATION

Please submit $25.00 application fee along with application

COMPLEX DESIRED: ______________________________ DATE NEEDED: _____________________

No. Of occupants: Adults: _______________________ Children: ________________

Projected Roommates’ Names: ________________________________

Full Name: ______________________________ _______________________________________________

Name Called: ____________________________ _______________________________________________

Pets: ___________________________________________

SS#: ___________________________________ Date of Birth (month/date/year): ___________________

Local Phone #: ___________________________ Cell Phone #: ____________________________________

E-Mail: __________________________________

CURRENT ADDRESS: ___________________________________City, State, Zip: ____________________

How Long: ______________________________ Landlord’s Name & Phone #: ______________________

Rent Payment: ____________________________ Fax :_____________________________________

PREVIOUS ADDRESS: ___________________________________City, State, Zip: ____________________

How Long: ______________________________ Landlord’s Name & Phone #: ______________________

Rent Payment: ____________________________ Fax :_____________________________________

EMPLOYER: ____________________________ STUDENT INFORMATION:

Position: _________________________________ College: __________________________________

How Long: _______________________________ Major: ___________________________________

Supervisor: _______________________________ Class: ____________________________________

Work Phone #: _____________________________ Fraternity or Sorority: _______________________

Driver’s License # and state: ________________________

Vehicle Make and Model: ____________________________ Color_____________ Year ___________

*EACH ADULT MUST COMPLETE A SEPARATE APPLICATION FORM.

PARENTS NAME OR PERSON TO CONTACT IN CASE OF EMERGENCY:

Name: __________________________________ Relationship: ____________________________________

Address: ________________________________ Phone: _________________________________________

City, State & Zip: _________________________ E-Mail: ________________________________________

------Only IN STATE checks-- money orders - cashier’s checks - accepted for rent------

NO CASH ACCEPTED

ALL UNITS ARE NON-SMOKING

NO PETS, WATERBEDS, OR BICYCLES ALLOWED IN APPARTMENT/HOUSE/DUPLEX UNLESS OTHERWISE AGREED UPON IN WRITING

I represent that the information provided in this application is true and correct to the best of my knowledge. Alice Henderson Realty & Rentals LLC is authorized to verify the reference and employment information given in this application and to request a credit check. I understand that I require no rights in a unit until I sign a lease in the form submitted to me and make a deposit of one month’s rent on the unit, which is to be held for the term of my lease.

Signature: _________________________________