ONLINE RENTAL APPLICATION

 

This is a preliminary application proceedure. Prequalification does not guarantee that we will have a home available for you or that we will rent to you. Income verification and past rent history will be examined when you have chosen a property.

NAME

ADDRESS

CITY

STATE

ZIP + 4

COUNTRY

SOCIAL SECURITY #

DATE OF BIRTH

PRIMARY ANNUAL INCOME

EMPLOYER

OTHER ANNUAL INCOME

SOURCE OF OTHER INCOME

DATE OF ANTICIPATED MOVE

ANYTHING YOU WANT TO SAY?

Segrest International REALTORS HAS PERMISSION TO CHECK MY CREDIT.

All adults living in the home must be approved.  Please indicate which property you wish to rent and your anticipated move-in date.

 

This form has been placed here in order to perfect the CGI scripts. The form process is not working correctly. Please print the form and fax it to (704) 563 0095 or make it into a file and email it to David Segrest.

 

form last update 6/30/05