occupant over the age of 18.

PERSONAL INFORMATION / INFORMACION PERSONAL

RENT INFORMATION / INFORMACION DE RENTA

EMPLOYMENT VERIFICATION / VERIFICACION DE EMPLEO

INCOME / SALARIO

Comprovantes de salario:

Ultimos 2 talones de cheque Cuenta de banco W-2

Comprovantes de salario:

Ultimos 2 talones de cheque Cuenta de banco W-2

Semana Quincena Mensual Año

Current Income $ _______________(Cuanto es su salario) $____________

Proof of income: Last 2 check stubs Bank statements W-2

Current Income $ _______________(Cuanto es su salario) $____________

Proof of income: Last 2 check stubs Bank statements W-2

Primary Contact / Aplicante Principal Secondary Contact / Aplicante Secundario

* If you've lived at current address for over 12 months, you don't need to fill out past landlord information. Skip to Employment section.* Si usted a vivido en su actual domicilio por 12 meces o mas, usted no tiene que llenar la información siguente. Valla a la parte que se llama Verificación de Empleo.

DL # State(Licencia de conducir) Estado

Last (Apellido)Middle (Segundo)Firtst Name (Primer Nombre)

S.S # (# de Seguro Social o I.T.I.N)

Por favor revise su aplicación antes de entregarla para ser procesada y asegúrese que ha llenado por completo todos los requerimientos apropiados y dado números de teléfonos, de esta forma nosotros podremos procesar su aplicación más rápido.

Please review your application before submitting it for processing. Please check to make sure we have complete information and phone numbers

What is your employement status: Full Time Part Time Student Unemployed(Cual es su estatus de trabajo) Tiempo Completo Medio Tiempo Estudiante Desempleado (a)

Supervisor(Supervisor)

Ph #(# de telefono)

Yrs Employed(Años Empleado)

Reason for Leaving(Razon por la que deja el lugar donde vive)

Rent/Month(Cuanto paga de renta al mes)

Date of Birth (Fecha de Nacimiento) / /

Marital Status Single Married Divorsed (Estado Civil) (Soltero) (Casado) (Divorciado)

Alias or Nicknames (Apodos)

Weekly Biweekly Monthly Yearly Semana Quincena Mensual Año

Phone # (# Telefono) Cell/Celular Home/Casa

Phone # (# Telefono) Cell/Celular Home/Casa

Email(Correo Electronico)

Rent Own (Renta) (Dueño)

Present Address(Direccion Actual)

City/State/Zip(Ciudad/Estado/Codigo Postal)

Length of Time(Tiempo viviendo en este lugar)

Present landlord(Nombre del propietario)

Landlord Ph #(# de Telefono)

Previous Home Address(Domicilio Anterior)

City/State/Zip(Ciudad/Estado/Codigo Postal)

Weekly Biweekly Monthly Yearly

Length of Time(Tiempo viviendo en este lugar)

Present landlord(Nombre del propietario)

Landlord Ph #(# de Telefono)

Reason for Leaving(Razon por la que deja el lugar donde vive)

Rent/Month(Cuanto paga de renta al mes)

Rent Own (Renta) (Dueño)

Current Employer(Donde trabaja actualmente)

Occupation(Ocupacion)

Hrs/Wk(Hrs por semana)

so we may expedite your application faster. Incomplete applications will delay processing. There is a $30 application fee for every

Aplicaciones incompletas detendrá el procedimiento de renta. La aplicacion cuesta $30 por persona mayor de 18 años.

Every occupant over the age of 18 MUST fill out a separate application (even if married.)

Toda persona de mas de 18 años de edad DEVERA llenar una aplicación (aun cuando estén casados)

RENTAL APPLICATION / APLICACION DE RENTA

PROPOSED OCCUPANTS / OCUPANTESAge(Edad)

Age(Edad)

Age(Edad)

Age(Edad)

Age(Edad)

APPLICANT QUESTIONNAIRE / CUESTIONARIO

EMERGENCY CONTACT / CONTACTO DE EMERGENCIA

PROPOSED PETS / MASCOTAS

VEHICLE(S) INFORMATION / INFORMACION SOBRE SUS VEHICULOSState(Estado)

State(Estado)

State(Estado)

City/State/Zip (Ciudad/Estado/Codigo postal)

Phone (Telefono)

Plate #(# de placas)

Year(Año)

Make(Marca)

Model(Modelo)

Color(Color)

Year(Año)

Make(Marca)

Model(Modelo)

Color(Color)

Plate #(# de placas)

Plate #(# de placas)

Year(Año)

Make(Marca)

Model(Modelo)

Color(Color)

Type / Breed(Tipo / Raza)

Name(Nombre)

Type / Breed(Tipo / Raza)

Name(Nombre)

Indoor Outdoor (Interiro) (Exterior)

Age / Wt(Edad / Peso)

Indoor Outdoor (Interiro) (Exterior)

Age / Wt(Edad / Peso)

Name(Nombre)

Relationship(Relación)

Occupation(Ocupación)

Name(Nombre)

Relationship(Relación)

Occupation(Ocupación)

Name(Nombre)

Relationship(Relación)

Occupation(Ocupación)

Name(Nombre)

Relationship(Relación)

Occupation(Ocupación)

Name(Nombre)

Relationship(Relación)

Occupation(Ocupación)

Have you ever filed bankruptcy?Alguna vez sea a declarado bancarota?

Yes /Si No

Have you ever been convicted of a felony?Alguna vez a sido condenado por alguna felonia?

Yes /Si No

Have you ever been taken to court by another landlord? Alguna vez ha sido llevado al corte por el propietario de donde vive?

Yes /Si NoIf you answered "yes" to any of the above questions regarding previous leases/landlords or convictions, please explain each one below. Si contesto "si' a una de las preguntas que tiene que ver con contratos o manejadores anteriores o con una conviccion, por favor explique cada uno abajo.

Have you ever been evicted from a rental residence?Lo han desalojado de su vivienda alguna vez?

Do you or anyone living with you smoke?Uste o alguna persona que viva con usted fuma?

Yes /Si No

Yes /Si No

Have you ever broken a rental lease? Ha usted quebrado un contrato de renta?

Yes /Si No

Name (Nombre)

Relationship (Relacion)

Language (Idioma)

Address (Direccion)

Yes /Si No

Do you have a checking/savings account?Tiene una cuenta de cheques o ahorros bancarios?

Do you have the first months rent & deposit amount available to pay now? Tiene el primer mes de renta y deposito disponible para pagar?

Yes /Si No

Please provide us with the name, address and phone number of an emergency contact.Por favor denos el nombre, direccion y numero de telefono de de un familiar o amigo como contacto de emergencia.

AGENCY REPRESENTATION DISCLOSURE / REPRESENTACION DE LA AGENCIA

of communication regarding the status and/or outcome of my application.

Landlord or Owner RepresentationA real estate agent who enters into a management agreement to manage property for a Landlord or Owner is known as

Anticipated move in date of _______________________

the Lanlord's Agent or Owner's Agent. A Landlord's or Owner's Agent represents the Landlord or Owner in the lease or rental transaction. That means that the Landlord's or Owner's Agent may assist the Tenant or Renter who is not represented in leasing or renting the Property or deal with an agent for the Tenant or Renter, but the Landlord's or Owner'sAgent's primary duty is to promote the interest of the Landlord or Owner. As a Tenant or Retner not represented by a

Applican't Signature Date

I agree to permit an investigation of my credit, tenant history,employment, criminal backgound and any otherscreening for the purposes of renting this property. If I supplied a valid email, I agree that it may be used as an official form

Landlord or OwnerAgent, you should keep any information that may place you at a disadvantage in negotiations confidential

I hereby apply to lease the property located at ______________________________________ unit # _____________ beginning on ________________________ at a monthly rent of $______________ and security deposit of $___________

Agency Representation Disclosure:

before you signed any document related to the transaction whom he/she is representing in the real estate lease/rental transacti

and undisclosed to the Landlord or Owner (Landlord's or Owner's Agent) since the Landlord's or Owner's Agent has a dutyto pass that information on to the Landlord or Owner. Confidential information may include the Tenant's or Renter's real estate needs or motivations, negotiating strategies or tactics, or financial situation.

Arkansas law requires real estate agents to disclose to all parties in a real estate lease or rental transaction which party(ies) he/she is representing. Real estate agents typically represent Landlords or Owners of real estate but can alsorepresent Tenants or Renters, as well as both. NEXTgen Corp. represents the Property Owner in this transaction.You will be asked to sign this application, which confirms that the Real Estate agent or representative disclosed to you

APPLICANT AUTHORIZATION

Thank you for your consideration and prompt reply, as it will avoid any delays.

Print applicant’s name Applicant’s signature Date

EMPLOYER’S VERIFICATION

Is the applicant currently employed? Yes No*If you answered “no,” there is no need to answer the remaining questions. Please fax the form back.

Length of employment: 0-6 months 6-12 months 12-24 months 24 months or longer

Is the employee eligible for a raise in the next 6 months? Yes No

If the employee is eligible for a raise, how much will it be and when will it take effect?

Additional comments:

Completed by: Title:

Signature: Date:

VERIFICATION OF EMPLOYMENT

requested and fax this form back to our office at (917) 283-0223. You can also email it to us at info@nextgenny.com.

The individual signed below has submitted a rental application to NEXTgen Corp. Please provide the information

NEXTgen Corp. is a division of Specialized Real Estate Group

APPLICANT AUTHORIZATION

Name of Applicant(s)

I hereby authorize release of the information requested below for my rental address at:

Street City State Zip

Applicant's signature Applicant's signature Date

LANDLORD’S VERIFICATION

Dates of residency: through Has lease expired? Yes No

Amount of rent: $

Number of late payments or NSF’s: None 1 2 3 4 or more

Did late payments occur within the last twelve months? Yes No

Has tenant complied with all community policies? Yes No

Does tenant keep an animal on the premises? Yes No

Has the animal at any time caused a problem or been a nuisance? Yes No

Is tenant eligible for re-rental? Yes No

Name & Title

Signature Date

VERIFICATION OF RENT

The individual(s) signed below submitted a rental application to NEXTgen Corp. Please provide the information requested and fax this form back to our office at (917) 283-0223. You can also email it to us at info@nextgenny.com. Thank you for your prompt response.

NEXTgen Corp. is a division of Specialized Real Estate Group

Sheet1

Middle Segundo: SS de Seguro Social o ITIN: Alias or Nicknames Apodos: Single: OffMarried: OffDivorsed: OffHomeCasa: OffLength of Time Tiempo viviendo en este lugar: Present landlord Nombre del propietario: Landlord Ph de Telefono: Reason for Leaving Razon por la que deja el lugar donde vive: RentMonth Cuanto paga de renta al mes: Rent: OffOwn: OffCityStateZip CiudadEstadoCodigo Postal_2: Length of Time Tiempo viviendo en este lugar_2: Present landlord Nombre del propietario_2: Landlord Ph de Telefono_2: Reason for Leaving Razon por la que deja el lugar donde vive_2: RentMonth Cuanto paga de renta al mes_2: Rent_2: OffOwn_2: OffCurrent Employer Donde trabaja actualmente: Occupation Ocupacion: HrsWk Hrs por semana: Supervisor Supervisor: Ph de telefono: Yrs Employed Años Empleado: Full Time: OffPart Time: OffStudent: OffUnemployed: OffCurrent Income: Cuanto es su salario: Last 2 check stubs: OffBank statements: OffW2: OffWeekly: OffBiweekly: OffMonthly: OffYearly: OffCurrent Income_2: Cuanto es su salario_2: Last 2 check stubs_2: OffBank statements_2: OffW2_2: OffWeekly_2: OffBiweekly_2: OffMonthly_2: OffYearly_2: OffName Nombre: Relationship Relación: Occupation Ocupación: Age Edad: Name Nombre_2: Relationship Relación_2: Occupation Ocupación_2: Age Edad_2: Name Nombre_3: Relationship Relación_3: Occupation Ocupación_3: Age Edad_3: Name Nombre_4: Relationship Relación_4: Occupation Ocupación_4: Age Edad_4: Name Nombre_5: Relationship Relación_5: Occupation Ocupación_5: Age Edad_5: If you answered yes to any of the above questions regarding previous leaseslandlords or convictions please explain each one below Si contesto si a una de las preguntas que tiene que ver con contratos o manejadores anteriores o con una conviccion por favor explique cada uno abajoRow1: If you answered yes to any of the above questions regarding previous leaseslandlords or convictions please explain each one below Si contesto si a una de las preguntas que tiene que ver con contratos o manejadores anteriores o con una conviccion por favor explique cada uno abajoRow2: If you answered yes to any of the above questions regarding previous leaseslandlords or convictions please explain each one below Si contesto si a una de las preguntas que tiene que ver con contratos o manejadores anteriores o con una conviccion por favor explique cada uno abajoRow3: If you answered yes to any of the above questions regarding previous leaseslandlords or convictions please explain each one below Si contesto si a una de las preguntas que tiene que ver con contratos o manejadores anteriores o con una conviccion por favor explique cada uno abajoRow4: Name Nombre_6: Relationship Relacion: Language Idioma: Address Direccion: CityStateZip CiudadEstadoCodigo postal: Phone Telefono: Type Breed Tipo Raza: Name Nombre_7: Indoor: OffOutdoor: OffAge Wt Edad Peso: Type Breed Tipo Raza_2: Name Nombre_8: Indoor_2: OffOutdoor_2: OffAge Wt Edad Peso_2: VEHICLES INFORMATION INFORMACION SOBRE SUS VEHICULOS: Make Marca: Model Modelo: Color Color: Plate de placas: State Estado: Year Año: Make Marca_2: Model Modelo_2: Color Color_2: Plate de placas_2: State Estado_2: Year Año_2: Make Marca_3: Model Modelo_3: Color Color_3: Plate de placas_3: State Estado_3: I hereby apply to lease the property located at: unit: beginning on: at a monthly rent of: and security deposit of: Anticipated move in date of: Date: Date_2: 612 months: Off1224 months: Off24 months or longer: OffIf the employee is eligible for a raise how much will it be and when will it take effect 1: If the employee is eligible for a raise how much will it be and when will it take effect 2: Additional comments 1: Additional comments 2: Completed by: Title: Date_3: through: Has lease expired: Amount of rent: None: Off1: Off2: Off3: Off4 or more: OffDate_4: Name Title: Date_5: DL: DL State: Email: Previous address: 06 months: OffYes1: OffNo1: OffYes: OffNo: OffFirst name: Last name: Present address: City State Zip: Birth day: Birth month: Birth year: Yes2: OffNo2: OffYes3: OffNo3: OffYes4: OffNo4: OffYes5: OffNo5: OffYes6: OffNo6: OffYes7: OffNo7: OffPrimary contact: OffSecondary contact: OffCellCelular: OnCell: OffHome: OffQ1yes: OffQ1no: OffQ2yes: OffQ2no: OffQ3no: OffQ3yes: OffQ4yes: OffQ4no: OffQ5yes: OffQ5no: OffQ6yes: OffQ6no: OffQ7yes: OffQ7no: OffQ8yes: OffQ8no: OffPhone: Phone2: