Application

You have a choice of filling out an application online and paying the $25 application fee using PayPal, or click the "Lease Application" link and print the form on your printer, fill it out and bring it in person with a $25 check to the leasing office at Wallace Ackley Co.

Click on the link below to view and print a Lease Application, you will need Adobe Reader to open the file if you need it download it here.

 

Lease Application

Fill out your application online

Last Name:
First Name:
Middle Name:
Social Security Number:
Date of Birth:
Driver's License Number:
Driver's License State:
Driver's License Expiration:
Home Phone Number:
Cell Phone Number: 		Present Address:
City: State:
Zip Code:
Date In:
Date Out:
Owner/Mgr Name:
Owner/Mgr Phone Number:
Reason for Moving:
E-Mail:
   
Previous Address:
City: State:
Zip Code:
Date In:
Date Out:
Owner/Mgr Name:
Owner/Mgr Phone Number:
Reason for Moving: 		Next Previous Address:
City: State:
Zip Code:
Date In:
Date Out:
Owner/Mgr Name:
Owner/Mgr Phone Number:
Reason for Moving:
   
List All Proposed Occupants in Addition to yourself
Present Occupation:
Salary: - Week/Month
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Zip Code:
Employer Phone Number:
How long with this employer:
Name of your supervisor: 		Prior Occupation:
Salary - Week/Month:
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Zip Code:
Employer Phone Number:
How long with this employer:
Name of your supervisor:
   
Checking Account Number:
Name of Your Bank:
Branch or Address:
Savings Account Number:
Name of Your Bank:
Branch or Address: 		Name of Creditor 1:
Address Phone Number:
Mo. Pmt. Amt.:
Name of Creditor 2:
Address Phone Number:
Mo. Pmt. Amt.:
Name of Creditor 3:
Address Phone Number:
Mo. Pmt. Amt.:
   
In case of emergency, notify
Name:
Relationship:
Phone:
Address:
City:
State:
Zip Code: 		Personal Reference 1
Name:
Relationship:
Phone:
Address:
City:
State:
Zip Code:
   
Personal Reference 2
Name:
Relationship:
Phone:
Address:
City:
State:
Zip Code: 		Personal Reference 3
Name:
Relationship:
Phone:
Address:
City:
State:
Zip Code:
   
Mothers Maiden Name:
Will you have pets:
- Describe
Liquid filled furniture:
- Describe		 Have you ever filed bankruptcy:
Have you ever been evicted or asked to move (describe)?

Have you ever used other names - If so list
 
   
Automobile 1
Make:
Model:
Year:
License No: 		Automobile 2
Make:
Model:
Year:
License No.:
   
By clicking on the submit button the applicant represents that the above statements are true and correct and hereby authorizes verification of items including, but not limited to the obtaining of tenancy and credit reports and agrees to furnish additional credit references upon request. Applicant certifies under penalty of perjury that the foregoing is true  and correct, and authorizes owner or his agents to obtain applicant's tenancy, credit and criminal history reports, and further authorizes owner and his agents to investigate the information provided herein, and that any material misstatement will at owner's option be a material and non-curable breach of any subsequent rental agreement and ground for immediate eviction.