Request for Residency Verification

TO: ___________________________ Fax Number: __________________________

The person(s) named below has made application for rental housing with V. S. Rich Property Services. The Applicant has authorized you to release information about his/her employment to us. Your cooperation will be sincerely appreciated.

Applicant:

Name(s): _______________________________________________

Address: _______________________________________________

                 _______________________________________________

Social Security Number: ______________________________

Applicant's Authorization of this inquiry

I hereby consent to the release of my employment information.

Applicant (s) Signature (s): ______________________ Date: ____________________

                                         _______________________ Date: ____________________

Property owner's or leasing Agents Information

Date of move in: __________  Date of move out: __________ Rental Rate __________

Utilities included: ________ Does tenant have any pets and what type if so? ____________

______________________________________________________________________

Number of late payments 6th - 10th day ________ 11th-15th day:_____ 16th-30th _______

Over 30 days______ Returned checks: ______

Have you ever had to file court papers on applicant? ______

If so, how may times? ______   Would you rent to applicant again? ______

Additional comment: ___________________________________________________

___________________________________________________________________

___________________________________________________________________

Signature: ____________________________ Title: ______________________

Date: _________________________________________-