Application

KAC Realty, LLC or Andy Clark
PO Box 16694, Greensboro, NC 27416
Office - 674-6203 E-mail: kacrealtyllc@hotmail.com Fax - 674-9909

Application to Lease

Unit Address

Date

Month Day Year Date Picker Icon

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

E-mail

Marital Status

Social Security Number

If e-mailing this form please do not include your social security number

Occupants *

Please list the names of all occupants

Current Address

Landlord Name and Telephone #

How long at this address

Current Rent Amount

Why are you moving?

Have you ever been evicted and/or are you currently in the process of being evicted?

Yes No

If yes, when?

Who's name will the utilites be in?

When would you like to move in?

Month Day Year Date Picker Icon

When will you have the deposit?

Month Day Year Date Picker Icon

How did you hear about us?

Emergency Contact

First Name Last Name

Emergency Contact

Area Code Phone Number

Employment Data: Applicant

Proof of Income is required.

Employer

Address

Contact

Position

Gross Monthly Income

Date Employed

Other Income, please explain

Employment Data: Co-Applicant

Proof of Income is Required.

Employer

Address

Contact

Position

Gross Monthly Income

Date Employed

Other Income, please explain

I/We am/are authorizing the Owner/Manager to investigate in its discretion employment, personal and credit references, prior evictions and any other items of information set forth in this application.

If any information on this application is found to be false, it will be grounds for refusal to rent or to continue renting from us and you agree to waive a refund of any money paid, and you agree this paragraph overrides any provision of any Lease Agreement, written or verbal.

I/We agree that if this application is accepted and I/we do not take the unit for which the hold fee was paid, the hold fee will not be refunded or transferred. The hold fee will be used as the security deposit once the lease is signed.

Applicant *

Co-Applicant

State Issued ID

Proof of Income