Pre-Qualification Application

Apartment Details

Bedroom(s) *

Location *

Occupancy Date *

Contact & Identification Information

Phone *

First Name *

Middle Initial *

Last Name *

Email *

Date of Birth *

Marital Status

Co-Applicant/Roommate Name (if none, please write "none") *

Spouse's First Name

Spouse's Middle Initial

Spouse's Last Name

Spouse's Date of Birth

Spouse's Email Address

Spouse's Phone Number

Name & Ages of Children

Total # of Occupants *

Have you applied with Bieck Management in the past 6 months? *

Pets

Present Address

Street *

City *

State *

Zip *

Length of Residence *

Landlord's Name *

Landlord's Phone *

Reason for Leaving

Previous Address

Street

City

State

Zip

Employment

Employer *

Employer Address

Employer Phone *

Supervisor's Name

How long have you been employed with present employer? *

Position *

Monthly Gross Income *

Spouse's Employment or Additional Income

Employer

Employer Address

Employer Phone

Supervisors Name

How long have you been employed with present employer?

Position

Monthly Gross Income

Banking / Credit

Bank

Checking

Savings

List Credit Cards or Other Credit

Emergency Contact Information

In case of an emergency notify *

Address *

Phone *

Relationship *

Vehicles

Vehicle 1

Model / Year / Color

Lic. Plate # / State

Vehicle 2

Model / Year / Color

Lic. Plate # / State

Vehicle 3

Model / Year / Color

Lic. Plate # / State

How did you hear about us? *

Other (Please Specify) *

Authorization to perform background checks:

With this application submission, applicant authorizes Bieck Management, Inc. to obtain a consumer credit report from a consumer-reporting agency.
If this application is not accepted, the deposit will be immediately returned in full.
Should the applicant fail to commence occupancy, the amount of earnest money permanently withheld by the landlord will be to the extent of the actual costs, damages, and lost rents (704.29) incurred.
Verbal notification of acceptance is satisfactory.
Applicant authorizes the Landlord to investigate credit, public records and financial responsibility, income, rental and eviction history, and the statements made in this application. Applicant understands that falsification of information may be the sole reason for rejecting the application. Submitting this form authorizes Bieck Management to perform these background checks.

Applicant Signature *

Today's Date *

Pre-Qualification Application

Bieck Management, Inc.