Emmit Moss Trust

P.O. Box 23787
Houston, Texas 77228
Office: 713-491-0040 / Cell: 281-543-0387
www.emmitmosstrust.com / mossproperties83@yahoo.com />
RENTAL APPLICATION
(PLEASE PRINT)
//Today’s Date:
PREMISES INFORMATION:
Address: Monthly Rent:$
By which date would you like to move in, if approved?
PERSONAL INFORMATION:
Tenant #1:
(text)
(Phone)
-)__Phone#:(__Name:
State:_DL/ID#:_//Social Security #:
(Social Security)
//Date of Birth:
(Date of Birth)
E-mail Address:_
Present Address:
(text)
_
Position Held:Employer:_
Pay Frequency: Weekly / Bi-Weekly / Monthly Income:$
(text)
//_Date of Hire:__
-)_Phone#:(_
(Phone)
Supervisor:_
Have you ever filed bankruptcy?:__Y / N//Y / N
(Have you ever been evicted?)
(combobox)
If yes, when?: Have you ever been evicted?
Y / N_Have you been convicted of or pled guilty to anything other than a traffic violation in the last 5 years?
(combobox) No
If yes, please briefly explain when and why:
(If yes, please briefly explain when and why)
Tenant #2:
(text)
-)__Phone#:(
(Tenant 2 Phone)
__Name:
State:_
(State)
DL/ID#:_
(DL/ID)
//Social Security #:
(Social Security)
//Date of Birth:
(Date of Birth)
E-mail Address:_
Present Address:
(text)
_
Position Held:_Employer:_
Pay Frequency: Weekly / Bi-Weekly / Monthly Income:$//_Date of Hire:__
-)_Phone#:(_
(Phone)
Supervisor:_
Have you ever filed bankruptcy?:
(combobox)
__Y / N//Y / N If yes, when?:
(If yes, when)
Have you ever been evicted?
(combobox)
Y / NHave you been convicted of or pled guilty to anything other than a traffic violation in the last 5 years?
(combobox)
If yes, please explain briefly and state the year:
*An eviction and/or criminal background does NOT automatically disqualify you from being approved*
RENTAL HISTORY:
Present:
(Rental History Landlord 1)
-
(text)
)_Phone#:(Landlord’s Name:
(Phone)
_
If yes, please list relationship:
(combobox)
Y / NIs this landlord a friend or relative?: _
Y / NDidi you sign a lease?
(combobox)
Length at Address:Rent Amount?:$_
Previous:
(Phone)
-Landlord’s Name:
(text)
)_Phone#:(_
If yes, Please list relationship:Y / NIs this landlord a friend or relative?:
(combobox)
_
Y / NDidi you sign a lease?
(combobox)
Length at Address:Rent Amount?:$_
ADDITIONAL OCCUPANTS:
Occupant #1:
-)__Phone#:(
(Occupant 1 Phone)
__Name:
(text)
Relationship to Tenant:_//_Date of Birth:
(Occupant 1 Phone Date of Birth)
__
Occupant #2:
-)__Phone#:(
(Occupant 2 Phone)
__Name:
(Occupant 2 Name)
Relationship to Tenant:_//_Date of Birth:
(Occupant 2 Phone Date of Birth)
__
Occupant #3:
-)__Phone#:(__Name:
(Occupant 3 Name)
Relationship to Tenant:_//_Date of Birth:
(Occupant 3 Phone Date of Birth)
__
EMERGENCY CONTACT:
Person #1 to notify in case of emergency:
-)__Phone#:(
(Phone)
__Name:
Address:
E-mail:
Person #2 to notify in case of emergency:
-)__Phone#:(
(Phone)
__Name:
Address:
E-mail:
PETS: (There is a $400.00, NON-REFUNDABLE fee for pets)
Pet #1
Is it an inside or outside pet?:_Type of animal?:_
Y / NIs pet caged/chained up?:_
(Pet 1 chained up)
Y / NDoes pet bite?:
(Pet 1 Pet bite)
Y / NAre pet’s shots/healthcare up to date?:
(Pet 1)
Pet #2
Is it an inside or outside pet?:_Type of animal?:_
Y / NIs pet caged/chained up?:_
(Pet 2 chained up)
Y / NDoes pet bite?:
(Pet 2 Pet bite)
Y / NAre pet’s shots/healthcare up to date?:
(Pet 1 health care)
REFERENCES:
Reference #1 (Relative):
Name:
Phone#:(__
)__
-
E-mail:
Relationship:
How long have you known them?:
Reference #2 (Relative):
Name:
Phone#:(__
)__
-
E-mail:
Relationship:
How long have you known them?:
Reference #1 (Co-Worker):
Name:
Phone#:(__
)__
-
E-mail:
Relationship:
How long have you known them?:
Reference #4 (friend):
Name:
Phone#:(__
)__
-
E-mail:
Relationship:
How long have you known them?:
MISCELLANEOUS INFORMATION:
How did you hear about Emmit Moss Trust?_
If referred by one of our residents, please tell us who:
Does anyone have additional income that is verifiable, such as social security, child support, or alimony?
Y / N_
If yes, from which source?:
Amount$:
*Any additional income listed will have to be proved as well, award letters ARE an acceptable form of proof*
PLEASE READ CAREFULLY AND INITIAL:
Tenant is not allowed to make changes to the property without the consent of the owner, in writing. Property will
be inspected prior to moving and at any time designated by the property owner.
Tenant may not keep any pet on the Property unless specifically authorized by this agreement and has paid a pet
fee. “Pet” includes any animal, whether mammal, reptile, bird, fish, rodent, or insect. Tenant can only have 2 pets per
household. The tenant must keep the shots of any pet current. Tenant is responsible and liable for: any damage to the
Property or any item in the Property caused by any pet; any personal injuries to any person caused by any pet; and any
damage to any person’s property caused by any pet. Tenant will protect, defend, indemnify, and hold Landlord,
Landlord’s property manager, and Landlord’s agents harmless from any damages, costs, attorney’s fees, and expenses
that are caused by the act of any pet or Tenant. Tenant must remove or confine any pet(s) at any time that the pet is
likely to limit or prohibit Landlord or other persons access to Property.
Tenant is aware that after 5 days of delinquency (lateness of rent) an Eviction process will begin with all expenses
assumed by the tenant. To avoid removal from the property the tenant will have to pay ALL late fees, eviction expenses
and rent due. If there is any reason the rent cannot be paid; please contact Moss Properties at 713-491-0040. Business
hours are 9:00 am – 5:00 pm Monday through Friday. If you have major work continually done it could cause an increase
in your rent. We recommend tenant should secure renter’s insurance; the owner will not be liable for damages due to
act of negligence of occupant, employees, patrons, visitors, or due to unauthorized repair(s). All maintenance should be
reported within 24 hours of problem(s).
PLEASE READ CAREFULLY AND INITIAL:
We will not accept personal checks, NO exceptions!! We will only accept money order or cashier’s check and you
can make them payable to:
EMMIT MOSS TRUST, PO BOX 23787, HOUSTON, TX 77228
SIGNATURES/AUTHORIZATION:
I hereby certify that the information I have provided above is truthful and complete. I understand that any false
or inaccurate information on my application could result in the denial of my application. I agree to pay a non-refundable
move in fee in the amount of $500.00 and if applicable a non-refundable pet fee of $400.00 PER PET.
Tenant 1 Signature_
Date:
/
/
Tenant 2 Signature_
Date:
/
/
DO NOT WRITE BELOW THIS LINE
FOR OFFICE USE ONLY
Application Taken By:__
Date:
/
/
Status: Approved / Denied / Withdrawn
Notified of status?: Y / N
Date: _
/
/
Move in Fee Required is $500.00 Move in Amount Received?:
Date Received:_
/
/_
Pet Fee Required is $400.00 Pet fee Amount Received?:_
Date Received:
/
/
"-----------------------"
Today’s Date: (required)

PREMISES INFORMATION:

Your Name (required)

Your Email (required)

Subject

Your Message

Δ