Lease Application - Treehouse Farm

Your Personal Information

First Name*

Middle Name

Last Name*

Date of Birth*

Format: mm/dd/yyyy

Social Security Number*

Format: 123-12-1234

Driver's License Number*

State of Issue*

Home Phone*

Cell Phone*

Email*

Preferred Method of Contact*

To ensure a timely application process please let us know the best way to contact you.

Do you currently rent or own where you live?*

Landlord's Name

First Last

Landlord's Phone

Monthly Rent*

Current Physical Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Years at Current Address*

Will you have additional, full-time occupants on the land?*

Yes
No

Additional Occupants

Name

First Last

Any additional, occupants on the land?*

Yes
No

Name

First Last

Any more occupants living with you on the land?*

Yes
No

Name of Additional Occupant

First Last

Current Address of Additional Occupant*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment and Income

Employment Status*

Employer or Business Name

Address of Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Your Business

Physical Address of Your Business

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Previous Employer

Previous Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Any additional income?

Source of additional income?

Additional income (interest, child support, etc.)

Do you have any mortgage, car or other loans?*

First Creditor Company Name

First Creditor Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number

Monthly Payment

Loan Balance

Second Creditor Company Name

Second Creditor Account Number

Second Creditor Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Second Creditor Monthly Payment

Second Creditor Loan Balance

Personal History

Additional comments can be made below before signing this document.

Have you ever been asked to move out or evicted?*

Have you ever broken a lease agreement?*

Have you ever declared bankruptcy?*

Have you ever been sued for non-payment of rent?*

Have you ever been sued for property damage?*

Have you ever been convicted of a felony?*

Local and Emergency Contacts

Emergency Contact Name*

First Last

Emergency Contact Phone*

Emergency Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Local Reference (if any)

First Last

Local Friend's Phone

Local Friend's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Will any pets, poultry or livestock be living on the land?*

Type

Number

Do you plan to grow Cannabis on the land?*

Are you a licensed patient in Hawaii or other state with a medical Cannabis program?*

Patient Number Issued by your state

Consent, Authorization and Signature

You have been asked to complete documents and a background screening authorization electronically and to receive legal notices electronically. To sign this authorization or any other document on this website electronically, fill out your name and last four digits of your Social Security number (“SSN”) and clicking the “Submit” button appearing at the bottom of the document. NOTE: Your electronic signature will not be applied to the document until you correctly complete all of these steps. Once the signature process is completed, your electronic signature will be binding as if you had physically signed the authorization by hand. If at any point you would like to withdraw your consent for your electronic signature, or if you need to update information needed to contact you electronically, please send your request to b@treehouse.farm. Any withdrawal of consent will be effective as of the date it is received. Please check this box if you consent to provide an electronic signature rather than a handwritten signature in connection with any application or background screening documents, and whenever you sign documents on this website.

Electronic Signature Consent*

I Agree
I Do Not Agree

My signature below indicates that I fully understand and agree with the agreements, terms and conditions of this application..*

In connection with my rental application, by checking the box and electronically signing my full name below, I authorize Landlord (the “Landlord”) to order a “consumer report” (a background check report) about me and to verify information I have provided on my rental application. I acknowledge the background report may contain information concerning my character, general reputation, personal characteristics, mode of living, and credit history/standing, and that such information may be obtained from law enforcement agencies, present or past employers or supervisors, landlords, finance bureaus/offices, credit bureaus, collection agencies, colleges, universities or other institutes of learning or certification, the military, and personal references. The types of information that may be ordered include, but are not limited to: criminal records check (as allowed by law), sex offender registry checks (as allowed by law), tenant history, verification of current or prior employment and salary, motor vehicle/driving history, education history, credit reports, or any other information requested from both public and private sources. I understand that I have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any consumer report or investigative consumer report. I understand that the nature and scope of the most common form of investigative consumer report obtained with regard to tenants is an investigation into my prior rental history, education, and employment. Selection criteria that may result in denial of my rental application includes: criminal history; previous rental history; credit history; or failure to provide accurate or complete information on the application form. I agree the Landlord may rely on this authorization to order background reports throughout my tenancy without asking me for my authorization again as allowed by law. I certify that all of the personal information I provided is true and correct.

Signing this authorization indicates that you have had the opportunity to review the Landlord's tenant selection criteria. The tenant selection criteria may include factors such as criminal history, credit history, current income, and rental history. If you do not meet the selection criteria, or if you provide inaccurate or incomplete information, your application may be rejected and your application fee will not be refunded. You further understand that if your application is accepted, the Landlord may report your performance as a lessee to credit reporting agencies.

I understand that by typing my name and the last four digits of my SSN and by clicking on the “Submit” button below, I am electronically signing the above document. I understand that my electronic signatures will be binding as though I had physically signed these documents by hand. I agree that a printout of this authorization may be accepted with the same authority as the original.

Applicant First and Last Name*

Date*

Last four digits of your social security number*