Northeast Hills, Ltd.
(936-564-4120 PHONE)

Request for Rental history Date:__________________
Phone Number:__________________________ Fax:_____________________________
Printed name ____________________________________________________________
and signature of contact person:_________________________________________
Position held:___________________________________________________________
(We will be contacting you to confirm the information on the form.)

REQUEST: Would you please provide us with the rental history of the following person who has given us a rental application. If there are any question about this form please contact our office.

APPLICANT'S NAME:_____________________________________________________________

PLEASE ANSWER the following questions. These questions relate to the time during which the applicant leased from you or from a former owner of the dwelling for which you have records.
(Please circle the correct response)

1. Has the applicant leased a dwelling from you in the past? YES NO Info unavailable
2. If yes, what was the address of the dwelling?________________________________________
3. What were the approximate dates that the applicant leased from you? From_______________________ to _____________________________
4. Did the applicant incur late charges more than once? YES NO Info unavailable
5. Did the applicant give NSF check(s) to management? YES NO Info unavailable
6. Did the applicant move out early or hold over in violation of lease? YES NO Info unavailable
7. Was the applicant asked to move out by management? YES NO Info unavailable
8. Was an eviction lawsuit filed against the applicant? YES NO Info unavailable
9. Did the applicant owe rent and/or other charges? YES NO Info unavailable
10. Did the applicant cause serious damage to the dwelling? YES NO Info unavailable
11. Did the applicant have a pet? YES NO Info unavailable
12. Was the pet? Authorized____ Unauthorized____ Information unavailable_____
13. Was the applicant given any lease violations in writing? YES NO Info unavailable
14. Please indicate the kind of lease violations, if any, for notice(s) or warning(s) given: ---------------
15. Is the applicant eligible to lease from you again? YES NO Info unavailable
16. Are you aware of whether the applicant has been arrested, convicted or received deferred adjudication for a violent or sexual crime? YES NO Info unavailable
17. Other information we should know?_______________________________________________

Copyright 1998, 2006
Robert Paty
and Bugscuffle Media