BDF Prequalification Form

This is NOT a lease or a rental agreement.

If applicable, the undersigned hereby is prequalifying for the home located at:  
If this is not for one home in particular, please type in "General"
If one or more of the items below do not apply to you, please type “NA” in the blank field(s) so
the application can submit at the end.  Thanks.

APPLICANT INFORMATION
Name				DOB				SSN
Email				DL#				Exp Date
Home Phone
Work Phone
Cell Phone
Name of Co-Tenant				DOB				SSN
Email				DL#				Exp Date
Present Address				City
How long at this address?				State
Landlord				Zip
Landlord Phone
Current Rent Amount
Current Lease Expires
Previous Address				City
Landlord				State
Landlord Phone				Zip

EMPLOYER & INCOME
		Present Occupation		Co-Tenant's Occupation
Occupation
Employer
Business Address
Business Phone
Type of Business
Position Held
Name of Supervisor
How Long There
Monthly Gross Income

If you respond "Yes" to any of the following questions, please provide the circumstances and/or details surrounding the event in question in the text box below it.
Have you ever filed a petition for bankruptcy?		Yes No
		N/A
Have you ever been evicted from any tenancy?		Yes No
		N/A
Have you ever been convicted of any crime?		Yes No
		N/A
Have you ever willfully and intentionally refused to pay rent when due?		Yes No
		N/A

The purpose of this application is to determine whether I qualify as a tenant. If my application is approved, the Landlord and I shall sign a written lease or rental agreement. The landlord and I have no rental agreement until the time that the lease or written rental agreement is signed.

I have paid the earnest money deposit and credit report fee indicated on this application. The earnest money deposit will be applied to my first month’s rent if the Landlord enters into a lease or rental agreement with me. If this application is approved, and I fail to enter into a lease or rental agreement, the earnest money and any subsequent payments may be retained to compensate the Landlord’s cost and damages. The earnest money and any subsequent payments will be refunded to me if this application is rejected. The credit report fee is nonrefundable.

My performance under any lease or rental agreement that I may enter into with the Landlord may be reported to a consumer credit reporting agency.

State and Federal law prohibit discrimination by any person engaging in real estate transactions on the basis of religion, race, color, national origin, age, sex, familial status, or marital status.

I expressly authorize the Landlord to obtain a credit report. I understand that if the Landlord denies my application based in whole or in part on the information contained in my credit report, that I am entitled to receive a copy of my credit report, free of charge, from the credit reporting agency supplying the report to the Landlord.

I agree that the Landlord may terminate any agreement entered into in reliance on any misstatement made above.

I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AUTHORIZE ITS VERIFICATION AND THE OBTAINING OF A CONSUMER CREDIT REPORT.

Are you applying to:
Buy
Rent-to-own
Rent

Check this box to sign the application