Log in to your account

Enter your username and password to log in




15314 E Hwy 12 Rogers Duplex - Upstairs

Rental Application for:

15314 E Hwy 12

Rogers, AR 72756

Some required fields are not filled out. They are indicated in the form below.

Questions marked with * are required.

Required Identification Fields
Email is required. Email must be in a proper format.

First Name is required.

Last Name is required.
Middle Initial *
Middle Initial is Required
Phone Number *
Phone Number is Required
Alternate Phone
Date of Birth *
Date of Birth is Required
Drivers License Number *
Drivers License Number is Required
Drivers License State *
Drivers License State is Required
Occupancy Limit
An application is required for any occupant 18 years of age or older.
Do you understand that the property has a TWO person limit per bedroom policy? *

Acknowledgement of 2 person limit is required.
Number of Dependents *
Number of Dependents is Required
Names and Date of Birth of Dependents *
Names and Date of Birth of Dependents is Required
Current Residence:
Street Address *
Current Street Address is required.
City *
Current City is required.
State *
Current State is required.
Zip Code *
Zip Code is Required
Dates for Current Residence:
Start Date in Current Residence *
Start Date in Current Residence is Required
End Date in Current Residence *
End Date in Current Residence is Required
Current Landlord *
Current Landlord is Required
Current Landlord Phone *
Current Landlord Phone is Required
Current Rent Amount *
Current Rent Amount is Required
1st Previous Residence:
Address *
1st Previous Address is required.
City *
1st Previous City is required.
State *
1st Previous State is Required.
Zip Code *
1st Previous Zip Code is Required.
Dates of 1st Previous Residence:
Start Date of Residence *
Start Date of 1st Previous Residence is required.
End Date of Residence *
End Date of 1st Previous Residence is Required.
Landlord *
1st Previous Landlord is required.
Landlord Phone Number *
1st Previous Landlord Phone Number is required.
Rent Amount *
1st Previous Rent Amount is required.
2nd Previous Residence
Address *
2nd Previous Address
City *
2nd Previous City is required.
State *
2nd Previous State is required.
Zip Code *
2nd Previous Zip Code is required.
Dates of 2nd Previous Residence:
Start Date of Previous Residence *
Start Date of 2nd Previous Residence is required.
End Date of Previous Residence *
End Date of 2nd Previous Residence
Previous Landlord *
2nd Previous Landlord is required.
Previous Landlord Phone Number *
2nd Previous Landlord Phone Number is required.
Previous Rent Amount *
2nd Previous Rent Amount is required.
Current Employer:
Employer Name *
Employer Name is Required
Employer Address *
Employer Address is required.
Employer City *
Employer City is required.
Employer State *
Employer State is required.
Employer Zip *
Employer Zip is required.
Employer Phone Number *
Employer Phone Number is required.
Position/Job Title *
Position/Job Title is required.
Supervisor's Name *
Supervisor's Name is required.
Hire Date *
Hire Date is Required.
Gross Wages per Month *
Gross Wages per Month is required.
Other Sources of Income
Explain Other Income
How long do you plan on living here? *
How long do you plan on living here? - must be answered.
What pets do you have? *
What pets do you have? - must be answered.
Do you have any dogs deemed to be a dangerous breed by insurance companies? *

Please confirm Yes/No to breed of dogs question.
Have you ever been charged, convicted, pleaded guilty or “no contest” to a felony? *

Please confirm Yes/No to general crime question.
Felony Convictions *

Please confirm Yes/No to Felony question.
Felony Type:
Sexual Misconduct
Drug Dealing/Manufacturing
Explain if Other
Have you ever been charged, convicted, pleaded guilty or “no contest” to a misdemeanor involving sexual misconduct? *

Please answer yes or no to sexual crime question.
Are you required to register as a Violent or Sex Offender in any state or jurisdiction? *

Please answer yes or no to Violent or Sex Offender registration question.
Have you ever filed for bankruptcy? *

Please confirm Yes/No for bankruptcy.
Have you ever been evicted from a tenancy? *

Please confirm Yes/No for evictions.
Have you ever broken a lease? *

Please confirm yes or now for breaking a lease.
Do you smoke? *

Please answer yes or now to smoking.
How many vehicles do you own? *
Please answer to the number of vehicles.
Is the total move-in amount available now? *

Please answer total move-in amount question.
When would you like to move in? *
Please answer requested move-in date.
How did you learn about the availability of this property? *

Please let use know how you learned about our property.
Name of person who referred you, if applicable.
For what reasons could you not pay rent on time? *
Please answer why you could not pay rent on time.
What is the balance of your checking account? *
Please answer your current checking account balance.
What is the balance of your savings account? *
Please answer your current savings account balance.
What is the balance of your retirement account?
Emergency Contact (Including to contact regarding rent or tenancy.) *
Please fill in your Emergency contact name.
Emergency Contact Number *
Please fill in your Emergency contact number.
Relationship to Emergency Contact *
Please answer you relationship of Emergency Contact.
Why should we rent to you? *
Please explain why we should rent to you.
Please use this optional space for additional information, comments, or explanations.
Please read carefully and sign and date below if you agree. Applicant certifies that the information contained in this application is true and correct. Applicant understands that false or misleading information is grounds for immediate disqualification. Applicant shall pay to the Landlord a nonrefundable fee to accompany this application to cover the Landlord's administrative costs and expense to verify the information submitted by the Applicant.
I authorize $30 screening fee. *
Authorization of the $30 screening fee is required.
Applicant authorizes the Landlord or Landlord's representatives to make any inquires deemed necessary to verify Applicant is the most qualified based on the below stated qualification standards. This verification includes, but is not limited to, direct contact with Applicant's employers, current landlord, previous landlords, friends, personal and professional references, law enforcement agencies, government agencies, consumer reporting agencies, public records, eviction records, and any other sources of information which the Landlord or Landlord's representative may deem necessary. Applicant verifies that the Landlord and Landlord's representatives shall not be held liable for damages of any kind that result from the verification of the information provided. This authorization shall extend through Applicant's tenancy to ensure continued compliance to the terms of tenancy or to recover any financial obligations relating to Applicant's tenancy, and beyond the expiration of Applicant's tenancy for recovery of any financial obligations, or for any other acceptable purpose. Should the Applicant be denied or face other adverse action based on information received in a consumer report, the Applicant has a right to obtain a free copy of the consumer report, and to dispute the accuracy of the information it contains by contacting the Consumer Reporting Agency:TransUnion, 2 Baldwin Place, P.O. Box 2000, Chester, PA 19022 or .
Holding Fee
Upon the verbal or written approval of the Applicant's tenancy, if tenant will not be taking occupancy immediately, a Deposit to Hold Agreement will be executed and signed by all parties and a non-refundable holding fee shall be required within 24 hours, hereinafter referred to as “Deposit to Hold” in the amount equal to one month's rent to hold the property until a mutually agreed upon move-in date.  Applicant understands that no rental will be held for more than 14 days. The Deposit to Hold removes the property from public offering and holds the home exclusively for the Applicant until all other requirements have been met.  After all requirements have been met and a lease for the property completed, the Deposit to Hold will transfer to the security deposit to be held throughout the tenant's entire tenancy. If the Applicant fails to provide the Deposit to Hold within 24 hours of approval, the Applicant may be disqualified and the home will be offered to the next qualified applicant. After approval and before occupancy will be granted, Applicant must supply all the required move-in funds, including the security deposit, first month's rent, and any other additional deposits and fees, all tenant paid utilities must be transferred into Applicant's name, and a lease must be executed and signed by all parties. If for any reason, the Applicant fails to complete all move-in requirements the landlord will return the property to public offering and the entire Deposit to Hold will be forfeited to the Landlord for expenses including, but not limited to, lost rent, holding costs, advertising costs, and marketing costs.
Qualification Standards
Your Application will be denied if you do not meet the below standards for qualification.
Applicant must have current photo identification and a valid social security number.
Applicant's monthly household income must exceed three times the rent. All income must be from a verifiable source. Unverifiable income will not be considered.
Applicants must receive positive references from all previous landlords for the previous 5 years.
Applicant may not have any evictions or unpaid judgments from previous landlords.
Applicant must exhibit a responsible financial life. Credit score must be a minimum of 600.
A background check will be conducted on all applicants over 18. Applicant's background must exhibit a pattern of responsibility.
If applicant is a pet owner, then please refer to the property's listing and rental agreement to verify pet policy BEFORE applying.
If applicant is a smoker, then please refer to the property's listing and rental agreement to verify smoking policy BEFORE applying.
An active checking account showing regular deposits from stated sources of income.
Occupancy limit is 2 people per bedroom.
At landlord's discretion, compensating factors such as an additional security deposit or co-signer (guarantor) may be required for qualification if Applicant fails to meet any one of the above requirements. In the event of multiple applicants, tenancy will be granted to the most qualified, based on the above criteria.
Applicant authorizes release of all information to Landlord and agrees that the information provided in this rental application is true and correct. This authorization extends beyond the end of Applicant's tenancy. Applicant hereby acknowledges they have also received the Rental Agreement and agrees to the terms stated in said agreement.
Applicant Authorization signature *
Applicant Authorized signature is required.
Authorization Date *
Authorization Date is required.
More Required Identification Fields
Legal Text Applicant authorizes the landlord/property manager to contact current and former landlord(s) or property manager(s), employers, creditors, credit bureaus, neighbors and any other sources deemed necessary to investigate applicant. All information above is true, accurate, and complete to the best of applicant’s knowledge. The landlord/property manager reserves the right to disqualify tenant if information is not represented.

Signing my full name in the following field qualifies as my legally binding signature per the Uniform Electronic Transactions Act (UETA).
Type Signature *
Signature is required.

Some required fields are not filled out. They are indicated in the form above.

Find us on Facebook Find us on LinkedIn
National Association of Residential Property Managers