REAL ESTATE RENTAL FORM
Application and Verification

(Have rental applicants sign this form to permit their banks to provide you with information needed to process their application.)

BANK REFERENCE VERIFICATION

From: _____________________ To:  Name of Bank _______________________

__________________________ Branch: _______________________________

__________________________ Address: ______________________________

                                                               City: _____________ State:____ Zip: ________

Re: Rental Applicant __________________________

I authorize you to give the requested information below to the following rental owner/company: __________________________________________

I also authorize for automatic bank drafts from my bank account so that I do not have to worry about mailing a rent check each month, or the possibility of mailing the rent late and having to pay late charges.

Signature: ___________________________  Date: _________________________

Dear Sir or Madam:

Your immediate reply is requested.  One of your bank customers, ___________________________, has

made an application with us for a rental home and has given your bank as a reference.

To assist us in processing the person's rental application, can you please supply us with the information requested below?  The applicant has given authorization so that this information may be released.  I have enclosed a self-addressed stamped envelope for your convenience or you may fax it to the following number __________________.

Your reply is appreciated and will be held in strict confidence.  If you need to contact me by phone, my number is _______________________________.

Thank you for your cooperation.

Rental Owner/Manager

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Rental Applicant: ______________________  Social Security # ____________________

Checking Account# _______________________  Date Opened: ___________________

Average Balance: ________ Would a check in the amount of $_________clear at this time?

Yes _____No ____ (This is the amount of monthly rent and/or deposit)

Savings Account# _______________________________  Date Opened: ____________

Average Balance _____________________________  Is this a joint account? _________

Does applicant currently have a loan through your bank? ___ If so, date loan created? _____

Loan# _______________________________ Monthly Payment Amount? ____________

Current Loan Balance? ________  Are payments current? ____ If not, how late? _______

This information provided by _______________________________________________

Bank Title: __________________ Date Completed: _____________________________