Lease Application

Please complete this form to be considered for a lease.

The unit is less than 1 mile from Baptist Hospital and less than 2 miles from Forsyth Medical Center.

Key Information

Rent is $1500/Month, which includes utilities and internet. $1600/Month for renting to two tenants.
You don't need to provide a security deposit.
There is a $150 Cleaning Fee
There is a non-refundable Pet Deposit of $200

This is an application for the rental of 2500 Miller Park Circle Unit D, Winston-Salem, NC 27103.

The application fee is $50.00. I require payment upon submission of the application.

I accept Venmo and Cash App. If you sign a lease with me, I will credit 50% of the application fee towards your first month’s rent.

In addition to completing this form, you will be asked to complete a background check using KeyCheck (https://www.keycheck.com/).

Name

First Name

Last Name

Email

Phone

(###)

###

####

Your Birth Date

MM

DD

YYYY

Your Permanent Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Desired Move In Date

MM

DD

YYYY

Desired Move Out Date

MM

DD

YYYY

Do you smoke?

Will you have a pet?

Small to medium-sized dogs are allowed, with a non-refundable $200 security deposit required. No cats are allowed. Provide breed, weight, and any other amplifying information in the comments box below.

Yes

No

Comments

Provide any additional information regarding your stay.

Ability to Pay

Upon acceptance of this application, are you able to pay the first month's rent ($1500), the Cleaning Fee ($150), and, if applicable, the non-refundable pet deposit ($200)?

Employment Information

What is your current or intended employer's name

Who is the Point of Contact and their Job Title?

e.g. John Smith / Hiring manager

What is the best way to contact them?

Provide either email address or phone number.

How long have you been employed there or what is your expected start date?

Rental History

Please provide information for the last two short-term rentals. If this is your first short-term rental, please provide information on past long-term rentals

Past Rental 1

Provide the following in the text box: 1. Landlord Name 2. Dates of your lease 3. Landlord Email 4. Landlord Phone Number

Past Rental 2

Provide the following in the text box: 1. Landlord Name 2. Dates of your lease 3. Landlord Email 4. Landlord Phone Number

Personal References

Please provide name and contact (Mobile Phone and email) information for at least two references

Reference 1 Name

First Name

Last Name

Reference 1 Email

Reference 1 Phone

(###)

###

####

Reference 2 Name

First Name

Last Name

Reference 2 Email

Reference 2 Phone

(###)

###

####

Additional Questions

Will You be the only tenant?

Yes

No

If you answered NO, who is the other tenant?

They may be required to complete an application, too. Note: There is a $100 per month up-charge in rent for two tenants.

Have you ever been evicted?

Yes

No

If you answered YES, please provide an explanation.

Are you willing to have a background check completed?

Yes

No

Adorable Ardmore Apartment Near Two Hospitals

Please complete this form to be considered for a lease.

Key Information