To get on the waiting list for any of these properties or for the
next purchased property please send ALL your contact
information and requirements to:
Waiting List
SMEDVIG Home Rental Application
Or simply read the information on the application below:

                             SMEDVIG Home RENTAL APPLICATION
Equal Housing Opportunity
Todays date:___________                     Your Last name_________________________________
The undersigned hereby makes an application to rent the home located at:
________________________________________________________________________________.  
Anticipated move date of ___________________at a monthly rent of $_______________ and security
deposit of $_______________, with a lease to purchase option of:_________________________
PLEASE TELL US ABOUT YOURSELF
Full Name______________________________________Home Phone (        ) _________________
Date of Birth:________________ Social Security #______________________
Email Address:__________________________________________
Other Phone (       ) ___________________type phone___________
Co-Applicant Name_________________________________________
Names of Dependents_________________________
Co-Applicant Date of Birth______________________  Social Security#____________________
Dependents Date of Birth_________________________________________________________
List All Pets____________________________________________________________________
PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)
Current Address__________________________Apt#________ City_________________
State______ Zip________Month/Year Moved In____________Out__________
Reasons for Leaving____________________________Rent $__________
Owner/Agent__________________________________Phone (       ) _____________
=============================================================================
Previous Address__________________________Apt#________ City_________________
State______ Zip________Month/Year Moved In____________Out__________
Reasons for Leaving____________________________Rent $__________
Owner/Agent__________________________________Phone (       ) _____________
=============================================================================
Previous Address__________________________Apt#________ City_________________
State______ Zip________Month/Year Moved In____________Out__________
Reasons for Leaving____________________________Rent $__________
Owner/Agent__________________________________Phone (       ) _____________

Your Last name_______________________

PLEASE DESCRIBE YOUR CREDIT HISTORY
We will be requesting a full tri-merged credit report to verify this information:

Are you currently or have you ever been party to a lawsuit?Have you declared bankruptcy in the past seven
(7) years?        Yes___________ No____________Yes___________ No____________
Have you ever been evicted from a rental residence?        Yes___________ No____________
Have you had two or more late rental payments in the past year?        Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due?        Yes __________  No____________

PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION
Your Status:  _____Full Time _____Part Time _____Student _____Unemployed
Employer________________________________________________
Dates employed- Start Date:___________End Date________ Title or Position:__________________
What do you do:____________________________________________________________________
Supervisors name____________________________________Phone (        )______________
Income or Salary $_________________per(how often received?)______________.  
Co Lessee’s employment info:
Status:  _____Full Time _____Part Time _____Student _____Unemployed
Employer________________________________________________
Dates employed Start Date:___________End Date:________Title or Position:__________________
Supervisors name__________________________________Phone (        )_____________________
Income or Salary $_________________per________________.
(If employed by above less than 12 months, give name & phone of previous employer or school:
_______________________________________________________________________
If you have other sources of income that you would like us to consider, please list income, source, and person
(banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child
support, or spouse's annual income unless you want us to consider it in this application.

Amount $______________per________________.
Source/Contact Name______________________________Phone (       )______________________
PLEASE LIST YOUR REFERENCES
Banking  Accounts:
Bank Name_________________ Type of Account_________Account Number_________________
Bank Name_________________ Type of Account_________Account Number_________________
Personal Reference or Emergency Contact:
Name _______________________ Address ___________________________________________
Phone _______________________ Relationship_______________________
                                       
                                              Your Last Name:_______________
Driver's License:
Your Driver's License Number_________________ State_________________
Vehicle Information:
Make / Model _________________Year _________________License Plate  State_________________
Make / Model _________________Year _________________License Plate State_________________
ADDITIONAL INFORMATION:
Please give any additional information that might help owner/management evaluate this application?
_________________________________________________________________________________
_________________________________________________________________________________

Where may we reach you to discuss this application?

Day Phone # (     ) ___________________________ Night Phone # (      )_____________________

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth
and agree that the rental is to be payable the first day of each month in advance. As an inducement to the
owner of the property and to the agent to accept this application. I warrant that all statements above set forth
are true; however, should any statement made above be a misrepresentation or not a true statement of facts,
all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.

I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted in 3
business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When
so approved and accepted, I agree to execute a lease for ___________ months before possession is given
and to pay the balance of the security deposit and any applicable lease purchase options prior to the move in
date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the
application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may
reject. I recognize that as a part of your procedure for processing my application, and investigative consumer
report may be prepared whereby information is obtained through personal interviews with others with whom I
may be acquainted. This inquiry includes information as to my character, general reputation, personal
characteristics and mode of living.
The above information, to the best of my knowledge, is true and correct.

Please sign:  X_________________________________________________________________
                 Name of Applicant                                                   Date
Please sign:  X_________________________________________________________________
                 Name of Co-Applicant                                              Date
AUTHORIZATION
Release of Information
I agree to permit an investigation of my credit, tenant history, banking and employment for the purposes of
renting with this owner/manager.

________________________________________
Name (please print)

X_______________________________________       __________________________
Signature                                                                                 Date

======================================================================================
APPLICANT:  PLEASE DO NOT WRITE BELOW  (FOR OFFICE USE ONLY)

Deposit of $__________________ Received by ____________________________ Date_______________

Conversation Log:
SMEDVIGS.com, LLC
Link to download a copy of the
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