Hinson Arms Apartments 3340 Richlands Highway Jacksonville, North Carolina 28540 910.455.1251

HINSON ARMS APARTMENTS 3340 RICHLANDS HIGHWAY JACKSONVILLE, NORTH CAROLINA 28540 910.455.1251 Rental Application Applicant Information Name: Date of Birth: SSN: Phone: Current Address: City: State: ZIP Code: Own Rent (Please circle) Monthly payment or rent: How Long? Previous address: City: State: ZIP Code: Owned Rented (Please circle) Monthly payment or rent: How Long? Driver's License No.: State: Expiration: / / / SSN: Do You Have Any Pets: Yes  No  How Many: Breed: Employment Information Current Employer: Employer Address: How Long? Phone: E-mail: Fax: City: State: ZIP Code: Position: Hourly Salary (Please circle) Annual Income: Previous Employer: Employer Address: How Long? Phone: E-mail: Fax: City: State: ZIP Code: Position: Hourly Salary (Please circle) Annual Income: Co-Applicant Information Name: | Driver’s License No.: State: | Do You Have Any Pets? Yes  No  Date of Birth: SSN: Phone: Current Address: City: State: ZIP Code: Own Rent (Please circle) Monthly payment or rent: How Long? Previous address: City: State: ZIP Code: Owned Rented (Please circle) Monthly payment or rent: How Long? Co-Applicant Employment Information (Continued On Page 2) Current Employer: Employer Address: How Long? Phone: E-mail: Fax: City: State: ZIP Code: Position: Hourly Salary (Please circle) Annual Income: Previous Employer: Employer Address: How Long? Phone: E-mail: Fax: City: State: ZIP Code: Position: Hourly Salary (Please circle) Annual Income: Applicant & Co-Application Banking Information Applicant Bank Name & Branch: Telephone Number: Checking Acct # Savings Account # Current Address of Bank: Loan Account # Monthly Payment $ Co-Applicant Bank Name & Branch: Telephone Number: Checking Acct # Savings Account # Current Address of Bank: Loan Account # References Credit Reference: Address: Phone: Credit Reference: Address: Phone: Personal Reference: Address: Phone: Personal Reference: Address: Phone: I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application.

Signature of Applicant: Date:

Signature of Co-Applicant: Date: Additional Information Total Number of Vehicles? Year/Model: Color: Tag No./State: Total Number of Vehicles? Year/Model: Color: Tag No./State: Other Car, Motorcycle, Etc.? Year/Model: Color: Tag No./State: TOTAL GROSS MONTHLY INCOME $$ HOW MANY PEOPLE WILL BE IN THE HOME: Name: Relationship: Telephone: Name: Relationship: Telephone: Name: Relationship: Telephone: Name: Relationship: Telephone:

HAVE YOU OR CO-APPLICANT EVER: Been sued for non-payment of rent? Yes  No  Been Convicted or asked to move out? Yes  No  Broken a Rental Agreement or Lease? Yes  Yes  Been sued for damage to rental property? Yes  No 

IN CASE OF EMERGENCY, NOTIFY (other than someone living with you):______Relationship?______Address: ______Phone/Work Number: ______I herby submit this application for an apartment and certify that this information is correct. I authorize you to contact any references that I have listed. I also authorized you to obtain my consumer credit report from your credit reporting agency, which will appear as an inquiry on my file. Applicant Signature: ______Date: ______Co-Applicant Signature: ______Date: ______

Application Approved? YES  NO  Date: ______Assigned Apt. No: ______Rent $$ ______By: ______Apt. Address: ______Applicant Notified By: ______Move In Date: ______