Rental Application
Shown By:_________________________		Date Shown:______________  For rental located at:______________________________________
Desired Term:	_______________	Monthly Rent:$___________________		Reservation Deposit Received:
From:____________ To: _____________				yes          no          Amount:$___________
Photo Identification: _____________		Social Security Number:________________________________
COMPLETE ALL REQUESTED INFORMATION IN ORDER TO EXPEDITE HANDLING OF THIS APPLICATION. THIS APPLICATION IS
SUBJECT TO APPROVAL AND ACCEPTANCE BY PREMIER REALTY 2000 INC. VALID PHOTO IDENTIFICATION AND SOCIAL SECURITY
VERIFICATION ARE REQUIRED TO BE SUBMITTED WITH APPLICATION.
Applicant:			Phone No.	Social Security No.	How long in Hawaii?	_____________
_____________________________________________________			_________________	________________
Co-Applicant:			Phone No.	Social Security No.	How long in Hawaii?	_____________
_____________________________________________________			_________________	________________
HOUSING	Present Address		From / To	Own / Rent	Landlord / Mortgage
Mortgage	___________________________________________		____________________		_______________________________
DATA					_______________________________
	City              State         Zip Code		Phone No.	Mo. Rent / Mortgage	Reason for leaving
	___________________________________________		____________________	_________________	_______________________________
					_______________________________
	Previous Address		From / To	Own / Rent	Landlord / Mortgage
	___________________________________________		____________________		_______________________________
					_______________________________
	City              State         Zip Code		Phone No.	Mo. Rent / Mortgage	Reason for Leaving
	___________________________________________		____________________	_________________	_______________________________
					_______________________________
EMPLOYMENT	Employer	Address		Supervisor	Telephone No.
DATA	_________________________________________________________________/			_________________	__________________
(Applicant)
	Position		Dates Employed	Monthly	Additional Housing
	___________________________________________		From / To:_____________	Salary:____________	Allowance:____________________
	Previous Employer		Dates Employed	Monthly	Additional Housing
	___________________________________________		From / To:_____________	Salary:____________	Allowance:____________________
	___________________________________________
	Other Income:$_____________		Source	Total Gross Monthly Income:$________________
			_____________________
			_____________________
EMPLOYMENT	Employer	Address		Supervisor	Telephone No.
DATE	__________________________________________________________________			_________________	__________________
(Co-Applicant)	__________________________________________________________________			_________________
	Position		Dates Employed	Monthly	Additional Housing
	___________________________________________		From / To:_______________	Salary:____________	Allowance:____________________
	___________________________________________
	Previous Employer		Dates Employed	Monthly	Additional Housing
	___________________________________________		From / To:_____________	Salary:____________	Allowance:_____________________
	Other Income:$_____________		Source	Total Gross Monthly Income:$________________
			_____________________
BANK DATA	Bank Name / Branch		Savings Acct. No.	Checking Acct. No.
	___________________________________________		_____________________	__________________
	___________________________________________		_____________________	__________________
MILITARY	Branch of Service		Duty Station	Supervisor	Telephone No.
PERSONNEL	___________________________________________		_____________________	__________________	__________________
ONLY	___________________________________________		_____________________	__________________
	Rate or Rank:_______	Length of Service	Mo. Salary $__________	Additional Housing	Date of Rotation
		_________________		Allowance:
				_________________	________________
	Commanding Officer		Telephone No.	Address:
	___________________________________________		_____________________	__________________________________
	Other Income	Source	Total Gross Monthly Income:$________________
	_________________________	_________________
CREDIT CHARGE	Firm Name / Branch		Account No.	Amt.      Mo. Pmt.	Loan Type
LOAN DATA	____________________________________________		_____________________	_____/___________	_________________
	Firm Name / Branch		Account No.	Amt.      Mo. Pmt.	Loan Type
	____________________________________________		_____________________	_____/___________	_________________
	Automobile (year)________	Make	Model / License No.	Mo. Pmt.	Loan Co.
		________________	________/____________	$____________	_________________
PERSONAL	Personal Reference (Hawaii Resident)		Personal Resident (Hawaii Resident)
REFERENCES	___________________________________________		_______________________________________
	Phone No.		Phone No.
	___________________		__________________
	In Case of Emergency Notify:
	Name:		Relationship:	Address	Telephone No.
	____________________________________________		_____________________	__________________	_________________
I HEREBY CONFIRM THAT ALL OF THE ABOVE INFORMATION HAS BEEN PROVIDED VOLUNTARILY AND IS ACCURATE
AND TRUE.  I HEREBY AUTHORIZE CONSUMER CREDIT REPORTING AGENCIES TO PROVIDE INFORMATION AS MAY BE
REQUIRED FOR SCREENING PURPOSES. ANY MISREPRESENTATION OF EMPLOYMENT, HOUSING, CREDIT OR LOAN
DATA MAY RESULT IN THE REFUSAL OF MY APPLICATION.
FURTHERMORE, I UNDERSTAND THAT SHOULD I CAUSE A FINANCIAL LOSS TO PREMIER REALTY 2000 INC. AGENT FOR
THE LANDLORD/OWNER. MY NAME WILL BE PLACED IN THE FILES OF A COLLECTION AGENCY AND TRANS UNION CREDIT
REPORTING SERVICES.  THIS INFORMATION WILL BE FURNISHED TO SUBSCRIBERS WHO HAVE A BONAFIDE AND
LEGAL NEED TO MAKE SUCH INQUIRES.
_____________________________________			___________________________
Applicant's Signature			Date
_____________________________________			___________________________
Applicant's Signature			Date