POINT WEST PROPERTIESINC.

Each and every person who will be residing at a given property must fill out an individual application. Any application without a social security number and bank account will not be processed. At the time that application is taken a $25.00 nonrefundable application report fee is to be paid by applicant.

For Confidential use by Management Only

Applying for Address:                                                                         Unit #                

Requested lease begin date:                            Name                                                       Date of Birth                    

Present Address:                                                                                

                                                                                    Phone(Home):                                    Work:                                              

Name of closest relative (Notify in emergency)                                                                            

Relationship                                          Phone                                                

Address                                                                                         

Do you presently: Rent      Own      How long?                     

Current Landlord:                                                                                       Phone #                                                         

Present Monthly rent or house payment: $                                    

Rental Address                                                                              

                                                                                                      Dates of residence:                      to                           

Have you ever been evicted or requested to vacate?Yes              No               

If so, Where                                                                               and When:                                     

Have you ever been convected of a felony?Yes             No                           

If yes, please explain:                                                                                                                                                                   

Occupational Information: Occupation                                                                                       

Employer’s address:                                                                                      

                                                                                                Phone                                                       How Long?                

Monthly Income $                            Other Source of Income (explain)                                                                         Amount$               

Social Security #:                -              -                   Drivers License #/state                                               

Banking Information:  Bank Name                                                                                Phone #                                             

Account # Checking                                           Savings                                               

Automobile Make:                                 Model Year                    License #/state                                                     

 Credit References:

Name                                                                                   Account #                                                     Phone                                      

Name                                                                                   Account #                                                     Phone                                  

Name                                                                                   Account #                                                     Phone                                  

 Disclaimer Release:  I agree that Point West Properties, Inc.  May release any and all rental history information about me regarding my leasing of said property applied for herein. I declare that the forgoing is true and correct and authorize it’s verification and the obtaining of a credit report as well as a civil and criminal history report. This releases the aforesaid parties from any liability and responsibility for collecting the aforesaid information. I understand that with this application I am paying $25.00 as a rental fee which will be non-refundable.

Signature of Application / Date

Deposit $                        Check #                            

Receipt of deposit is hereby acknowledged to secure the tenancy of the premises. This deposit is received subject to Agent’s approval and acceptance of this rental application submitted by applicant. If the application is approved by Agent, Applicant shall promptly sign a lease for the premises containing the above terms and in the form customarily used by Agent. At this time the above deposit will be applied first against the security deposit and then against rent due under said lease. In consideration of Agent’s promise to hold the above premises available for the use of applicant, in the event this application is approved, applicant agrees to execute said lease after approval by Agent, or elects not to occupy said premises, then all sums paid hereunder may be applied against all damages or losses incurred by Agent in holding said premises exclusively for Applicant included but not limited to advertising, administrative costs and rent until the premises are rerented. Applicant acknowledges that he/she has completed this rental application and that the information supplied herein is true and correct. This rental application becomes a part of the lease. Applicant representations made in the rental application shall be considered inducements to Agent to execute the agreement. Misrepresentations in the application shall be considered as cause to terminate the lease. Earnest money check can be cashed at any time do NOT leave a check if you do not intend for it to be cashed immediately!!

Signature of Application / Date                           Signature of Manager / Date