Credit Report Request Form
1. Name:
SSN:
DOB:
Home #:
Work or Cell #:
2. Name:
SSN:
DOB:
Home #:
Work or Cell #:
Have you, a relative, or a friend ever lived in one of our properties?
Yes No
Current Address:
City:
Zip:
How Long?:
Landlord:
Contact #:
Reason:
Number of Dogs:
Which Kinds?:
Number of Cats:
Closest Relative:
Phone #:
Relationship:
Address:
Current Rent/Mortgage:
Includes Utilities?:
Yes No
Date Due:
Late Payments?:
Yes No
How Many Last Year?:
Reason:
Number of Occupants:
Info:
1. Employer:
Title:
How Long?:
Hours/Week:
Salary:
Per:
Hr. Wk. Mo. Yr.
Proof of Income if Self-Employed:
Yes No
Source:
Additional Income:
Amount:
Per:
Wk. Mo. Yr.
2. Employer:
Title:
How Long?:
Hours/Week:
Salary:
Per:
Hr. Wk. Mo. Yr.
Proof of Income if Self-Employed:
Yes No
Source:
Additional Income:
Amount:
Per:
Wk. Mo. Yr.
Security Deposit is required at the time of signing. How much do you have available right now?
Amount:
Property Interested In:
How Did You Find Out About This Property?:
I/We hereby give authorization to Cornerstone Homes, Inc. to run an in-house credit report and the information I/We give on this report can be used for any future attempts for collections. Therefore, the above information is supplied to Cornerstone.
I/We hereby certify that the information provided is correct to the best of my/our knowledge and will provide proof of it at the signing of the rental agreement.
** Please fill in all required fields.