R.F. Miller Properties, Inc.

1. There is an application fee of $20 for each application processed; each applicant must fill out a separate application. This must be paid by cash or money order BEFORE this application is processed. NO personal checks will be accepted! This application fee is NOT refundable.

2. Anyone over age 18 who will be living in the house must fill out and sign an application.

3. Answer all questions truthfully. Be sure to complete BOTH SIDES of the application. All information will be carefully checked. False information will result in automatic rejection of this application. If you have questions, call our office.

Last Name_______________________ First__________________________ Middle ____________

Social Security #_____________________ Date of Birth: ______________Telephone (_____) ______________

Driver’s License #_________________________ Driver’s License State __________________

Other Occupants: (Include persons who regularly visit on an overnight basis)

Name _______________________________________ Name _____________________________________

Name _______________________________________ Name ______________________________________

License Plate #_______________ State______ Make__________________ Year_____ Color_________

Street __________________________ Apt.________ City ___________________ State____ Zip_______

Landlord’s / Mortgage Co’s Name____________________________ Telephone (____)_______________

Address___________________________________ City__________________ State_____ Zip__________

How long lived there? ______ years, ____ months. Your monthly rent/mortgage payment $____________

Number of Bedrooms Rented _____ Reason for Leaving_________________________________________

Name as it appears on bill for: Gas & Electric Co. _____________ Water Co. _____________________

Street _____________________________ Apt.______ City ________________ State____ Zip_________

Landlord’s / Mortgage Co’s Name_____________________________ Telephone (____)______________

Address_________________________________________ City____________ State____ Zip__________

How long lived there? ______ years, _____ months. Your monthly rent/mortgage payment $____________

Number of Bedrooms Rented _____Reason for Leaving_________________________________________

Current Employer______________________________ Supervisor_________________________________

Address_____________________ City____________ State___ Zip______ Phone(___)________________

Length of Time Employed ___yrs.___ mos. Position_______________ Monthly Income $_____________

If yes: How many________ Breed: __________________________ Names:________________

Do you understand there is a $100 pet deposit and an extra $25 in rent per month per pet? YES NO

Other Sources of Income: Source______________________ Monthly Income $________ Source_______________________ Monthly Income $________

o MasterCard o Visa o Discover o Gas / Department Store o Other (specify:____________)

Have you ever been convicted of any crime other than a minor traffic offense? ( ) Yes ( ) No

Have you ever had any judgments or other legal proceedings against you? ( ) Yes ( ) No

Have you ever been served an eviction notice / been asked to vacate a property you were renting?( ) Yes ( ) No

Have you ever willfully or intentionally refused to pay rent when due? ( ) Yes ( ) No

Do you know of anything which may interrupt your income or ability to make payments? ( ) Yes ( ) No

If your answer is “yes” to any of the above questions, please provide complete details below:

_________________________________________________________________________________________________

I am depositing along with this application the sum of $20.00 Dollars as a non-refundable application fee. I have re-examined the information which I have provided on this application, and I agree that it is true and complete. Except as noted above, (1) I have never been, nor am I now being, dispossessed or evicted from any rental unit; (2) I have never broken or in any manner failed to honor a lease or rental agreement. I understand that providing false or incomplete information on this application shall be grounds for immediate rejection of application or eviction.I understand that R. F. Miller Properties, Inc. must receive deposit within three (3) days of notification of acceptance in order to hold the property for me. All initial payments including security deposits, down payments, option fees and first month’s rent must be made in cash, certified check, cashier’s check or money order. I also understand that if this application is accepted and I decide not to take up residence in the premises, my application fee AND MY DEPOSIT will be forfeited.

All applications will be process in the order received. The application AND application fee must both be submitted to begin processing. ALL INFORMATION WILL BE VERIFIED! It takes 1-2 business days to process applications.

Your application WILL AUTOMATICALLY be rejected for the following 3 reasons:

I hereby authorize R. F. Miller Properties, Inc. to obtain information concerning my past and present credit, rental, or employment history. I hereby authorize any of the following sources, including but not limited to (1) credit reporting agencies, (2) public or privately owned utility companies, (3) governmental housing agencies, and (4) current or past landlords, employers, or creditors to release any said information to the above named party. I hereby release any of the above sources from any liability for damages of any kind whatsoever, whether caused by negligence or not, which may at any time result to me by reason of compliance with the above mentioned inquiry, which may include the answering of specific questions and the giving of any information concerning my present or past record. Additionally, I give the above named party permission to copy and submit this form as needed.