Confidential Personal Information 

Print this document, return via email, fax, or mail w/ $50.00 Rental Application Fee

Mailing Address:   A Home Suite Home, LLC    19706 One Norman Blvd, Box #137, Cornelius, NC  28031

Fax:  877-252-0408                    Email:  AHomeSuiteHome@aol.com

            I, __________________________ (Tenant) give A Home Suite Home authorization to complete a Background Check for this Rental Application.  Information will not be shared w/ any private nor distributed for any purpose other than A Home Suite Home.

Tenant Signature:  _____________________________________   Date: ________________

Name of Applicant(s):________________________Birth Date:___________________                       

                                          ________________________                 ___________________           

Telephone:_________________________Mobile Phone:_________________ 

Driver's License No.& State:______________________ 

Social Security Number:  ________________________ 

Weekly Rentals only -for Damage Deposit via PayPal(Credit Card).  

Credit Card Number:  _________________________ Expiration: _____________   Type: ________________

Email Address:____________________________ Primary   ____________________________Secondary

Reason for Lake Norman Rental: ____________________________

Tentative Beginning and Ending of  Duration:___________________ 

Present Address:____________________________________________________ 

City:____________________ State:________   Zip:_______Duration:_______________ 

Prior Address:______________________________________________________________________ 

City:___________________________ State:________   Zip:___________ Duration:_____________ 

How many will be living in the unit: Adults____________   Children____________  No Pets/Smoking Allowed 

Employer:__________________________________  Occupation:_________________________ 

How long:___________________  Telephone:____________________ 

Address:_________________________________________________________________________ 

Bank Information 

Bank Name:______________________________    Branch Telephone:______________________ 

Address:_________________________________________________________________________ 

Checking Account No.:_______________________Saving Account No:____________________ 

Personal References           

Name                                           Relationship                      Telephone/Mobile Number     

1.____________________________________________________________________________ 

2.____________________________________________________________________________ 

3.____________________________________________________________________________       

Other Information 

Car Make/Model:_____________________________________Year:________Color:_____________ 

License Tag No._________________________ State:_____________ 

Car Make/Model:_____________________________________Year:________Color:_____________ 

License Tag No._________________________ State:_____________

Have you ever:

        Filed for Bankruptcy: ________Yes  ________No   (If yes, when:_______________________)       

        Been served an eviction notice or asked to vacate a rented property?_________Yes _________No 

        Willfully or intentionally refused to pay rent when due?_______Yes  ________No 

                                                                                            (If yes, when:_______________________) 

        Been sued for unlawful detainer?___________Yes  ___________No 

How were you referred by us?  __________________________________We would like to thank them for the referral!

Fair Credit Reporting Act(FCRA)

Falsification of this information is grounds for a ten day Notice to Move, if discovered later by A Home Suite Home.