Questions? Call 479-202-4797

 Rental Application

All information must be completed.  The decision to rent to you will depend in great part on your credit history and references. Owner/Agent/Operating manager is a licensed Real Estate Agent in the state of Arkansas and is associated with EPI*Center Realty, LLC, 120 N. Commercial, Ste 2, Springdale AR 72764.
EACH ADULT APPLYING FOR UNIT MUST COMPLETE A SEPARATE APPLICATION.

Need a paper version of the application? Click Here

Landlord Name: Lierly Lane Properties  PO Box 6636  Springdale, AR 72766
Address of Premises: Seneca Ave Fayetteville, AR 72704

Your Information
Email Address :   
First name 
Last Name
Contact Phone Number
Work Phone Number
Present Address
City
State Zipcode  
How Long?
Apartment Name:
Landlord Name:
Landlord Phone Number
Why are you leaving?
Current Rent:
Present Employer
Phone:  
Position  
How Long?  
Gross Income before deductions
Other income:
Other Income Source:
Credit References
Check all that apply:
Checking Account 
Savings Account   
Are ALL your credit accounts current:
Have you ever been evicted?
Have you ever had a foreclosure/repossession?
If Yes, Date:
Explain
Have you ever filled for bankruptcy? If Yes 
Explain:
Do you own:  
Vacuum cleaner  Waterbed
 
Musical instruments:
Smoker:
Have you ever been convicted of a crime, other than a traffic violation?
If yes, explain
Pets
No pets are allowed at any time on the premises without prior Management consent and payment of fees. NO EXCEPTIONS.
Name Type
Weight    
Name Type
Weight    
*NOTE: No pets are allowed at any time on the premises without prior Management consent and payment of fees. NO EXCEPTIONS.
Date of desired occupancy (MM/DD/YYYY)
Anticipated length of stay
Authorization
Electronic Signature Agreement. By entering your full name in the Accept box, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.
I declare that the application is complete, true and correct and I herewith give my permission for anyone contacted to release the credit or personal information of the undersigned applicant to Management or their authorized agents, at any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended.
I further authorize Management or their Authorized Agents to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employers and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement entered into with Management. Any false information will constitute ground for rejection of the application, or Management may at any time immediately terminate any agreement entered into in reliance upon misinformation given on this application.
 
 I Accept ( type your full name)