Background Check Authorization Form
Purchase or Rental For Married Co-Applicants /Do Not Leave any Blank Space
Applicant Information
Prefix First Name Last Name
SS#
Date of Birth
Month Day Year
Date
Driver's License#
State
Spouse Information
Last Name First MI Maiden
SS#
Date of Birth
Month Day Year
Date
Driver's License#
State
Present Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Previous Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Have you ever had adjudication withheld or been convicted of a crime?
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
Clear
Date
Month Day Year
Date
Spouse's Signature
Clear
Date
Month Day Year
Date
Should be Empty:

Background Check Authorization Form