First Name (Legal name - no nicknames!): *
E-mail Address: *
Middle Initial *
Last Name *
Home Phone: *
Business Phone:
Mobile Number:
Street Address:
Zip Code:
Do you currently own or rent?
How Long? *
Monthly Rent
Previous Street Address *
Previous City *
Previous State *
Do you authorize Rob Rahter of Keller Williams or our affiliated companies to check your credit history? * Yes, I hereby authorize the use of my SSN and birthdate to run a credit check. I understand the outcome greatly impacts the decision to sell to me. I understand this information will be used solely for this purpose and all resulting information will be held confidential. THE COST IS $40 WHICH WILL BE PAID BY ME BEFORE THE SEARCH AND IS NON-REFUNDABLE.
No, do not run my credit. I have a recent credit report that I will submit for review. I understand if I fail to submit a credit report, this application will not be considered.
How Long?
Work Address
Work Phone
Supervisor Phone
Gross Monthly Income (before deductions)
Monthly Child Support Payments
Monthly Alimony Payments
Monthly Car Payments
Cash in Savings
Car Make
Car Model
License Plate
Car #2 Make
Car #2 Model
Car #2 License Plate
I declare that the application is complete, true and correct and I herewith give my permission for anyone contacted to release the credit or personal information of the applicant to Management or their authorized agents, at any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended. I further authorize Management or their Authorized Agents to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employers and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement entered into with Management. Any false information will constitute ground for rejection of the application, or Management may at any time immediately terminate any agreement entered into in reliance upon misinformation given in this application. *

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