Thank you for your interest in this property. 
For questions regarding the property or this application, please contact Noel Bruns (weekdays) at 815-732-7240.

Return completed application(s) to:
4th and Long, LLC
Attn: Noel Bruns
127 South 4th Street
Oregon, IL 61061	             or email 4thandlong@ablesoftsolutions.com 

FOR OFFICE USE ONLY	
Address
	Unit
	
Monthly Rent
	Other
	
Your ability to qualify for this rental is based on the accumulated income and assets of all applicants signing the lease.  Please, attach a completed APPLICANT PROFILE (next page) for each applicant.
APPLICANT(S) NAMED ON THE LEASE	
Name (First, Middle, Last)	Birth Date	Relationship to Applicant(s)	

			
			
OTHER OCCUPANTS / CHILDREN	
Name (First, Middle, Last)	Birth Date	Relationship to Applicant(s)	

			
 	 	 	
Other	
1.      What is your desired move-in date?
 	
2.      What email address may we use to communicate with you?
 	
The signer(s) hereby certify that to the best of his/her knowledge, the information provided in this rental application is true, complete, and accurate. The signer(s) hereby authorize a credit and/or criminal check to be made, verification of information provided, and communication with any and all names listed on this application. The signer(s) understand that any discrepancy or lack of information may result in the rejection of this application. The singer(s) understand that a credit report that reveals credit issues such as slow pay, charge offs, collections or judgments could cause the application to be rejected. If the application is denied based on information contained on the report, the signer(s) have the right to obtain a copy of the report from the reporting agency.

The signer(s) also understand that this is an application for property rental and does not constitute a rental or lease agreement in whole or part. The signer(s) further agree(s) to provide additional information on request and to notify the Landlord promptly of any material change in the information provided in this application.

APPLICANT SIGNATURES	
APPLICANT NAME	SIGNATURE AND DATE		APPLICANT NAME	SIGNATURE AND DATE	

APPLICANT PROFILE      (Required for EACH applicant.)	
Name (First, Middle, Last)
 	Cell Phone
 	Have you ever been evicted?         	
Maiden Name or Alias
 	Work Phone
 	Have you ever filed for bankruptcy?      	
Birth Date
 	Email Address
 	Have you ever been convicted of a crime?         	
SSN
 	Driver’s License Number
 	If “yes” above, please explain:
 	
Street Address               City                                 State                           Zip Code
 		
RENTAL/RESIDENTIAL HISTORY	
	Current	Previous	
Dates (from/to)	 	 	
Address, City, State Zip	 	 	
Monthly Rent Paid	 	 	
Owner/Manager Name	 	 	
Owner/Manager Phone	 	 	
Reason for Leaving	 	 	
EMPLOYMENT HISTORY	
	Current	First Previous	
Date Employed (from/to)	 	 	
Employer	 	 	
City, State	 	 	
Occupation	 	 	
Est. Monthly Earnings	 	 	
Reason for Leaving	 	 	
CURRENT INCOME
**You need not include alimony, child support, or other income if you do not want it considered as a basis for acceptance.	
Income Source **	Monthly Income ($)	

		
VERIFICATION OF EMPLOYMENT IS REQUIRED, IF ACCEPTED.  (e.g. CURRENT PAYSTUB, EMPLOYMENT CONTRACT)	
COUNT BALANCES	
Financial Institution	Account Type
(savings/checking/other)	Estimated Balance	
1.      	 	 	 	
2.      	 	 	 	
3.	 	 	 	
CURRENT DEBT – LOANS AND CREDIT CARDS	
Financial Institution	Account Type
(Visa, MC, Loan, etc.)	Purpose of Debt	Estimated Balance	
1.      	 	 		 	
2.      	 	 		 	
3.	 	 		 	
AUTO-TRANSFER SAVINGS	
We offer a $25 monthly discount for auto-transfer rent payments from your bank.  Would you implement?  (Y/N):