RENTAL APPLICATION INSTRUCTIONS 

• Please fill in all blanks completely!
• Completed applications along with the $50 application fee may be dropped off at one of the following rental offices:
  • 2916 Amanda Drive, Jeffersonville, IN
  • 1545 E. 10^th Street, Jeffersonville, IN
  • 3401 Prestwick Square Drive, Jeffersonville, IN
  • 2150 Heritage Way, #49, Corydon, IN
  • 220 Timothy Lane, Hanover, IN
• Each applicant over the age of 18 is required to submit a separate application and $50 application fee. Married applicants only need to submit ONE application and ONE fee of $50. Applications will not be reviewed until BOTH applicants have submitted applications and fees. Co-applicants need to be listed on each party’s application.
• Pinnacle Properties upholds a no cash policy! Applications that are accompanied with cash will not be processed! Processing fees can be submitted through a money order or cashier’s check. Applications submitted online must be paid with Credit Card.
• If an agent is not at the office when you drop off your application, you may drop your application and payment in the rent drop box.
• Please list your monthly gross income, not your take home income. Example – if you make $10.00/hour and you work 160 hours/month, your gross income would be $1,600.00.
• For applications submitted online, applicants may fill out their Employment Verification and Verification of Rental History form. Please provide valid contact information for both employer and prior landlord. We pride ourselves in getting applicants processed in a timely manner. If landlord/employers are unable to be reached, this may delay the approval process. For application’s submitted in person or to the rental office, please have your employer and prior landlord fill out the Employment Verification Form and Verification of Rental History form.
• PLEASE NOTE: Special rates change frequently. Pinnacle Properties will honor special prices for a maximum of 24 hours from the day you take the application. Applications retuned after the 24-hour period will be at the current rental rate.

THANK YOU FOR CHOOSING PINNACLE PROPERTIES!

Alternatively, you can download our application, print it out and return the completed application to us.

Requested Address Please Select

Personal Information

First Name

Middle Initial

Last Name

Former Last Name

Email

Primary Phone

Birth Date

Social Security Number

Occupation

Your License #

Vehicle Make

Vehicle Model

Vehicle Registration State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Vehicle Color

Vehicle Plate #

Emergency Contact

Phone Number

Income and Employment

Current Employer

Supervisor Name

Supervisor Phone

Employer Address

Employer City

Employer State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employer Zip

Employed Since

Monthly Income

Additional Income

Type of Additional Income

Previous Employer Name

Previous Employer End Date

Previous Employer Start Date

Previous Employer End Date

Current Address

Street Address

City

State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Date You Moved In

Monthly Payment

Landlord's Name

Landlord's Phone

Reason for Leaving

Additional Occupants

*Co-applicant’s over the age of 18 must also fill out a separate application unless applicant’s are married*

First Name

Middle Initial

Last Name

Former Last Name

Email

Primary Phone

Birth Date

Social Security Number

Occupation

Your License #

Vehicle Make

Vehicle Model

Vehicle Registration State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Vehicle Color

Vehicle Plate #

Emergency Contact

Phone Number

Current Employer

Supervisor Name

Supervisor Phone

Employer Address

Employer City

Employer State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employer Zip

Employed Since

Monthly Income

Additional Income

Type of Additional Income

Previous Employer Start Date

Previous Employer End Date

Prior Address

City

State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Date You Moved In

Monthly Payment

Landlord's Name

Landlord's Phone

Reason for Leaving

Please list any additional occupants who are under the age of 18 years’ old.

Name

Birth Date

Relationship

Name

Birth Date

Relationship

Name

Birth Date

Relationship

General Questions

Have you or any occupant listed in this application ever been sued for rent? Please Select Yes No

Have you or any occupant listed in this application ever been sued for property damage? Please Select Yes No

Have you or any occupant listed in this application ever been evicted or asked to move out? Please Select Yes No

Have you or any occupant listed in this application ever moved out of a dwelling before the end of the lease term without consent of the owners? Please Select Yes No

Have you or any occupant on this application ever had bed bugs in your home? Please Select Yes No

Have you or any occupant listed on this application ever been charged, detained, or arrested for a felony, misdemeanor involving a controlled substance, violence to another person or destruction of property, or a sex crime that was resolved by conviction, probation, deferred adjunction, court ordered community service, pretrial diversion or has not yet been resolved? Please Select Yes No

If yes, please explain:

Have you or any occupant listed on this application ever declared bankruptcy? Please Select Yes No

Are there any past credit problems you or any occupant on this application wish to explain? Please Select Yes No

If yes, please explain:

Do you or any occupant listed on this application own a pet? Please Select Yes No

Name/Breed

Age

Weight

Verification of Rental History

Are you currently a leaseholder or occupant? Please Select Leaseholder Occupant

Did the you give proper notice of intent to vacate? Please Select Yes No

Do you have any pets? Please Select Yes No

Do you have a record of paying rent promptly? Please Select Yes No

If you paid late, how many days late?

If you paid late, how often?

Do you still owe money to your current landlord? Please Select Yes No

Did you keep your apartment clean? Please Select Yes No

Did you, your occupants and/or guests damage/vandalize common areas in the community? Please Select Yes No

If yes, please explain?

If yes, did you pay for the damage? Please Select Yes No

Employment Verification Information

Presently Employed? Please Select Yes No

Date First Employed

Date Last Employed

Current Wages/Salary

Wages/Salary Issued Please Select Hourly Weekly Bi-Weekly Monthly Yearly Other

Average # of regular hours per week

Year-to-date earnings

Through Date

Overtime Rate

Average # of overtime hours per week

Shift Differential Rate

Average # of shift differentials per week

Commission, bonuses, tips, other

How often? Please Select Hourly Weekly Bi-Weekly Monthly Yearly Other

List any anticipated change in rate of pay within the next 12 months

Effective Date

If your work is seasonal or sporadic, please indicate the layoff period(s)

Authorization

I have read and agree to the application agreement.

I have read and agree to the consent to credit and criminal background.

I hereby authorize full investigation and verification of all rental history information .

I hereby authorize release of my employment information.

Applicant Name

Date

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