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Larson Investments, LLC

119 Belknap St. Superior, WI 54880

218-428-1204 hollylarson11@gmail.com

Please read this carefully and sign.

The purpose of this application is to determine whether I qualify as a tenant. If my application is approved,
the Landlord and I shall sign a written lease or rental agreement. The Landlord and I have no rental
agreement until the time that the written agreement is signed, I understand that more than one applicant
may be applying for the same property.
I have paid the $30 application fee. Once I pay the earnest money deposit, it will be applied to my security
deposit if the Landlord enters into a rental agreement with me.
If this application is approved, and I fail to enter into a lease or rental agreement, the earnest money and
subsequent payments may be retained to compensate the landlords costs for damages, subject to the
Landlords duty to mitigate.
The earnest money and any subsequent payments will be refunded to me by the end of the 4h business day
if this application is rejected, or withdrawn by me before approval. If my application is denied, a denial letter
with a copy of the credit check and applications will be delivered by U.S. Mail to my currant address or
emailed to the email address I have listed on the application.
The application fee of $30 is non-refundable.
I acknowledge that the Manager and agents and employees threof represent the interests of the Landlord,
but they also have the duty to treat all parties fairly in accordance with the fair housing law, and to disclose
material adverse facts about the property.
I warrant and represent that I am at least 18 years of age and that all statements herein are true and correct,
to the best of my knowledge.
Notice: You may obtain information about the sex offender registry and persons registered with the registry
by contacting the Wisconsin Department of Corrections on the internet at http:www.widocoffenders.org or by
phone at 877-234-0085.
Consent to release Information
I hereby authorize the Landlord and Manager to investigate my credit and financial responsibility, income,
rental and eviction history, and the statements made in this application, and obtained consumer report on
me from a consumer reporting agency that complies and maintains files on consumers on a nationwide
basis. My performance under any lease or rental agreement that I may enter into with the Landlord may be
reported to such reporting agency.
Signature of
Print name______________________________________________________________________

Property Information
Monthly rent__________________________ Move in Date requested___________________________

Applicant Information
Name first_______________________________ Middle _________________Last_______________________
Maiden name or other names used__________________________________________________________
Date of birth________________________ Social security
Phone #________________________________________ Cell phone _________________________________
Name(s) of Other persons to occupy unit (non-applicants)
1.__________________________________________ Birthdate__________________________
2.__________________________________________ Birthdate__________________________
3.__________________________________________ Birthdate__________________________
4.__________________________________________ Birthdate__________________________

Applicants rental history


Lease dates _____________to ____________

Landlord Name _____________________________________ Phone Number_________________________

Previous Address ________________________________City__________________ State_______
Rent$__________ Lease dates ______________to ___________________
Landlord Name____________________________________ Phone Number______________________

Make and model_____________________ Year______________ License#________________ Color_____

Applicants Employer and Income

Present employer________________________________________________
Phone _____________________ Date started____________________ Monthly pay________________
If receiving financial aid for college please note here. _______( Please provide copy of
College Attending______________________________________________________

Please circle one

Have you ever failed to pay rent when due? YES NO
Have you ever been evicted? YES NO
Do you have a pet(s)? YES NO #____

Emergency contact and References (Non-family and immediate family)

Emergency contact
Name ___________________________ address___________________________________________________
Relationship____________________________________________ Phone

1. Name____________________________________ phone #_______________________________
2. Name____________________________________ phone #_______________________________

We are working with the city, neighbors and other Landlords in this area to maintain the quality of the
neighborhood. Therefore, we use screening procedures to evaluate each prospective tenant before we
rent. These procedures are listed below. Please review our criteria below and if you feel you meet the
criteria, please apply. Please note that we provide equal housing opportunity; we do not discriminate
the basis of race, color, religion, sex, disability ,nation of origin, family status, marital status, sexual
orientation, lawful source of income, age, ancestry, and status as a victim of domestic abuse, sexual
abuse, or stalking.
We must receive one completed rental application from each adult 18 years of older applying. The
application fee is $20 for credit check and $10 for criminal and reference check for a total of $30.00
per applicant. If the completed application contains omissions (not satisfactory explained) It will be
returned to you before we proceed the application process. If incorrect social security number is
provided, an additional credit check fee will be applicable.
Personal ID
We require a photo ID to be presented with your completed application.
Rental History
It is your responsibility to provide us with the necessary information to contact your previous landlords.
We reserve the right to deny your application if, after making a good faith effort, we are unable to
verify your rental history.
You may be denied if:
1. You misrepresent any information on the application. If misrepresentations are found after
agreement is signed, your rental agreement will be terminated.
2. In the past 5 years, you have had any conviction for any type of crime.
3. Your credit check show accounts that are not current or your credit score is less than 550.
4. If you have ever been evicted.
5. Previous landlord references are poor or they would be disinclined to rent to you again for any
reason pertaining to the property during your tenancy such as: excessive non-life/safety police
calls, excessive noise, lack of proper care of the premises, inadequate pet maintenance,
unauthorized guests on the property, or conflicts with other tenants or neighbors.
Earnest Money deposit
There is earnest money deposit required that is conditionally refundable. If you are accepted the
earnest money will be applied to your security deposit. If you withdraw your application after you have
been accepted, certain deductions, allowed by law, will be made. You may review a copy of the rental
agreement and all written rules and regulations before you complete this application or pay any
earnest money.
I have read and understand the screening criteria.