Qualifying Form

ONLY TO BE FILLED OUT BY POTENTIAL BUYER(S)

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Thank you for your response. ✨

Full Name

DOB

DL# & SS#

Phone Number

Employer

Address

Occupation | Hire Date

Supervisor Name & Phone#

How long at present job?

Gross monthly pay?

Check all that apply.

Have you declared bankruptcy in the past 7-years? Have you ever been evicted from a rental residence? Have you had 2 or more late rental payments in the last year? Have you ever broken a lease or rental agreement? Have you ever willfully or intentionally refused to pay rent when due? Do you have an account with a utility company? Do you have any outstanding late payments? Do you have any criminal history or legal restrictions?

Please explain, if any of the above has been checked.

RESIDENTIAL HISTORY

Current Address

Rent or payment per month

Have you always paid on time?

Month/Year Moved In

Reason for leaving?

Owner/Agent & Phone

Previous Address

Rent or payment per month

Have you always paid on time?

Month/Year Moved In

Reason for leaving?

Owner/Agent & Phone

I hereby state that all information on this form is true and correct. (Enter your full name and date below after reading disclaimer)

The applicant represents to EZ Housing Concepts LLC (EZHC) that all the information provided is true, accurate and complete to the best of Applicant’s knowledge and further agrees that if any such information is not as represented, the Applicant may, at EZHC’s sole discretion, be disqualified as a tenant at any time before or during tenancy. I also agree that an incomplete application or missing information requested may disqualify me form consideration. By my signature below, I hereby give my permission to EZHC and any other company, attorney, or third party used to locate persons or information, to use any of the information in this form at any time to be investigated and locate my current and past addresses, rentals, credit, background, criminal and employment history and I authorize the release of all information to them until my agreed obligations are fulfilled. I understand that if by filling out this form it is not a guarantee for acceptance by EZHC. EZ Housing Concepts LLC and/or any third party, other companies or persons are not liable to the applicant, their heirs, executors, administrators or assigns for any damage of any kind, actual or consequential by reason of the verification by the owner of the information provided by the applicant and, applicant hereby releases the owner, his agent(s), employees and /or representatives from any and all actions, causes of action of any kind or nature that my arise by virtue of the execution of the agreement provided herein.

ONLY TO BE FILLED OUT BY POTENTIAL BUYER(S)

Thank you for your response. ✨

RESIDENTIAL HISTORY

I hereby state that all information on this form is true and correct. (Enter your full name and date below after reading disclaimer)

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