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round Check Authorization Form
FOR PURCHASE OR RENTAL
727-869-9700 727-869-9825 (Fax)
Unmarried Co-Applicants Fill Out a Separate Application. Do NOT leave any blank spaces.
Name ____________________________________________ SS# _______________________ DOB _____ / _____ / ________
Last First MI Jr./Sr. Month Day Year
Driver’s License # __________________________________ State _________ (Please Attach Copy to Application)
Spouse ___________________________________________ SS# _______________________ DOB _____ / _____ / ________
Last First MI Maiden Month Day Year
Driver’s License # __________________________________ State _________ (Please Attach Copy to Application)
Phone: (______)________________________________
Present Address ____________________________________________________________ From _________ To _________
Street Apt. # City ST Zip
Previous Address ___________________________________________________________ From _________ To _________
Street Apt. # City ST Zip
Have you ever had adjudication withheld or been convicted of a crime?
Applicant: Yes _____ No _____ Spouse: Yes _____ No _____
AUTHORIZATION OF RELEASE OF INFORMATION – Applicant(s) represent(s) that all of the above information and
statements on the application for purchase/rental are true and complete and hereby authorizes an investigative
consumer report including, but not limited to, residential history (rental or mortgage), employment history, criminal history
records, court records and credit records. This authorization must be signed before it can be processed by
management. Applicant acknowledges that false or omitted information herein may constitute grounds for rejection of
this application, termination of right of occupancy, and/or forfeiture of fees and/or deposits and may constitute a criminal
offense under the laws of this State.
NON-REFUNDABLE APPLICATION FEE – Applicant(s) agree(s) to pay $_________ for a non-refundable application
processing fee.
Applicant’s Signature: ______________________________________ Date: __________________
Spouse’s Signature: ______________________________________ Date: __________________
Other’s Signature: ________________________________________ Date: __________________