APPLICATION FOR RENTAL
TO BE COMPLETED BY EACH ADULT APPLICANT
BUILDING:______________________ UNIT #__________ ID CONFIRMED:____________
(INITIALS)
RENT $_______________ SECURITY DEPOSIT $_______________ SCREENING CHARGE $_______________
DATE_____________________________________________DATE UNIT WANTED________________________________________
APPLICANT’S FULL NAME_____________________________________________________________________________________
PREVIOUS NAMES, ALIASES OR NICKNAMES USED_______________________________________________________________
DATE OF BIRTH__________________SSN_________________________EMAIL__________________________________________
APPLICANT DRIVERS LICENSE #_________________________STATE_________PHONE #_______________________________
CURRENT ADDRESS__________________________________________________________________________________________
CITY_____________________STATE_______ZIP_______________ DATE YOU MOVED IN_________________________________
CURRENT LANDLORD NAME______________________________________PHONE______________________________________
LANDLORDS ADDRESS_________________________________________CITY_______________STATE_______ZIP___________
FORMER ADDRESS___________________________________________________________________________________________
CITY________________________STATE_______ZIP_______________FROM_____________________TO____________________
FORMER LANDLORD NAME_____________________________________PHONE________________________________________
CURRENT EMPLOYER_____________________________________________PHONE_____________________________________
ADDRESS_______________________________________________CITY____________________STATE_______ZIP____________
POSITION________________________________GROSS MONTHLY INCOME $________________HOW LONG?______________
OTHER MONTHLY INCOME: SOURCE______________________________________________ $____________________________
PREVIOUS / ADDITIONAL EMPLOYER________________________________________________PHONE_____________________
NAME
DATE OF BIRTH
___________________________ ____________
___________________________ ____________
___________________________ ____________
MAKE
VEHICLES
OTHER
OCCUPANTS
POSITION________________________________GROSS MONTHLY INCOME$________________HOW LONG?_______________
MODEL
COLOR
STATE
LICENSE PLATE #
_____________________________________________
_____________________________________________
_____________________________________________
PETS (NUMBER & TYPE)______________________________________________________________________________________
DO YOU INTEND TO USE: _____WATERBED _____AQUARIUM ______MUSICAL INSTRUMENT:__________________________
HAVE YOU EVER BEEN EVICTED OR ARE YOU CURRENTLY IN THE EVICTION PROCESS? NO_____ YES_____ WHEN?__________________
HAVE YOU OR ANY OTHER PERSON WHO WILL BE OCCUPYING THE UNIT EVER BEEN CONVICTED OF, OR PLED GUILTY OR NO CONTEST
TO, ANY FELONY? NO_____ YES_____ IF YES, WHO______________________WHERE______________________WHEN___________________
WHAT___________________________________________________________________________________________________________________
HAVE YOU EVER HAD BEDBUGS? NO_____YES_____IF YES, EXPLAIN___________________________________________________________
WHY ARE YOU VACATING YOUR PRESENT PLACE OF RESIDENCE?_____________________________________________________________
HOW DID YOU HEAR ABOUT US?___________________________________________________________________________________________
I certify that the above information is correct and complete and hereby authorize you to do a credit/criminal check and make
any inquiries you feel necessary to evaluate my tenancy and credit standing. I understand that giving incomplete or false
information is grounds for rejection of this application. I understand that if any information supplied on this application is
later found to be false, this is grounds for termination of tenancy. I have received and read the Owner/Agent’s rental criteria.
________________________________________________________________
APPLICANT
_____________________
DATE
revised 7.11.14
RENTAL SCREENING CRITERIA, GENERAL INFORMATION
ABOUT RENTING AND RECEIPT FOR APPLICATION FEE
Building Name/Address_____________________________________________________Unit #______________Rent______________
Manager Name__________________________________Phone #________________________Application Fee Paid______________












RENT, DEPOSITS AND FEES
$45 non-refundable application fee per adult
First month’s rent (Note: First month’s rent is the full rent amount. The second month’s rent is pro-rated as needed)
Security Deposit (1 to 2X monthly rental amount based on screening)
Pet Security Deposit if applicable ($250 for first animal, $125 per additional animal. Limit of 2 per unit)
Non-Compliance Fees may be charged for: Late payment of a utility or service charge that the tenant owes the landlord, failure
to clean up pet waste, failure to clean up garbage, parking violations, improper use of vehicles, smoking in a posted nonsmoking unit or area, and unauthorized pet. The first non-compliance notice is a warning only with no fee applied. The second
notice may include a fee up to $50, and it must be within one-year after the previous warning notice for a same or similar
infraction of the rental agreement. The third and subsequent notice may include a fee up to $50 plus 5% of the monthly rent.
th
Late Rent Charge: $50 when paid after the 5 of the month
NSF Charge: $35 plus any amount charged by the bank plus possible late fee
Lease Break fee is 1.5X the monthly stated rent or landlord may choose to charge for damages.
Smoke detector tampering fee: $250
New key charge:________ Lock out charge:________
Utilities CPP pays: ____water/sewer; ____garbage; ____heat; ____electric;____gas:____
Utilities you pay: ____water/sewer; ____garbage; ____heat; ____electric; ____gas; cable; phone
UTILITIES AND PHONE NUMBERS
Residents must call to have the utilities established in their name before move-in
NW Natural Gas: 503.226.4210
Century Link:
800.475.7526
Comcast Cable: 888.824.8264
Parking Permits: 503.823.5185
PGE: 503.228.6322
Pacific Power and Light: 888.221.7070
SCREENING PROCEDURES
Applications are taken on a first-come, first-serve basis and are screened prior to approval. Applications are not considered
complete until you have viewed the apartment, completed the application entirely and submitted the non-refundable screening fee.
Applicants must be 18* or older and must provide two pieces of ID, one with picture ID. A credit/criminal check may be supplied by the
credit bureau Experian and/or AppFolio Inc. A decision is generally made within 24 hours.
Once approved, you have 24 hours to pay a minimum $150.00 execution deposit to secure the apartment until the agreed upon
move-in date. Units are normally held for no more than 7 calendar days. If you fail to pay the $150.00 execution deposit within 24 hours,
the unit applied for will be released to the next approved applicant. All rent and deposits must be paid and all forms completed prior to
release of the keys and taking occupancy. Your execution deposit will be applied to your total move-in costs. If you move in during the
middle of the month, we will prorate your second month’s rent.
If you fail to rent the apartment and pay all sums due within the stated time period, then you will have no right or claim to the
apartment, the landlord will retain all sums collected, and the unit will be offered to another applicant. If your application is approved, at
least three attempts will be made to contact you over a 12 hour period. If we are unable to reach you, we will process the next submitted
application, and you will have no right or claim to the apartment. If the application is denied, then you will be notified by phone, email
and/or first class mail.
*Applicants must be at least 18 years of age, or under the age of 18 and married, emancipated or under the age of 18 and (a and/or b): a) pregnant and
expecting the birth of a child who will live in the primary applicant’s physical custody; b) the parent of a child or children living in the physical custody of the person.
APARTMENT CONDITION
All units are thoroughly cleaned, painted or touched up, and in good repair prior to move-in. Any deficiencies or repair items
should be reported in writing on a maintenance request form to the manager. Tenant alterations, including painting, are not permitted.
Apartments built before 1978 may contain lead based paint. A pamphlet containing information on lead based paint will be
given to you upon move-in. Asbestos was commonly used in plaster, pipe insulation and in some floor coverings. While we are unsure
whether your unit contains any asbestos, you need to take extra care not to disturb any suspected surfaces.
MOVING
Please check with your building manager about specific moving requirements, particularly for buildings with elevators. Elevators and
front doors cannot be blocked off at any time for moving purposes, nor is it permissible to block parking. Moving should be done during
daytime or early evening hours and never between 10PM and 9AM. Any damage to the building occurring during the move is your
responsibility. All boxes must be broken down for recycling. It is your responsibility to properly dispose of all unwanted items. Removal
of any furniture, garbage or other items left in the apartment or on the grounds at the time you vacate will be charged directly to you.
Page 1 of 2
APPROVAL CRITERIA:
Rental History: Applicants must have at least two years of positive verifiable rental history from third party unrelated sources. If there
are less than two years of prior rental history, the option of an increased security deposit may be considered. Applicants must provide
names and phone numbers of previous landlords. Incomplete or misrepresented information will result in denial of the application. Any
eviction reported as occurring in the last 5 years will result in the denial of the application. Any eviction reported as occurring more than
5 years prior to the application date will require a security deposit equal to 2X’s a full month’s rent and a minimum of 2 years positive
third party rental history. Any other negative rental history reported regarding payment history or other problems in which a landlord
would not re-rent will result in denial of the application.
Income Requirements: Applicants must have at least 2 years of verifiable legal income history. The total household income must be at
least 2.5 times the amount of the rent. Applicants must provide names and phone numbers of employers or sources of income.
Verifiable legal income may include, but is not limited to: employment income, alimony/child support, trust accounts, social security,
student loans, sect. 8 housing voucher or grants. If the applicant’s monthly income does not meet this requirement, the option of an
increased security deposit may be considered. Self-employed applicants must furnish a copy of the most recent Federal tax return. If we
are unable to verify an adequate legal income source, your application will be denied.
Credit Reports: A credit report will be obtained for all applicants. Any rental based collections will result in denial of the application. A
bankruptcy within 24 months will result in denial of the application. An increased security deposit may be considered in the following
instances:

If an applicant’s bankruptcy is older than 24 months, a 2X’s security deposit may be considered.

If an applicant has an average credit score with no more than 4 collections, a 1.5X’s security deposit may be considered.

If the applicant has an average credit score with no more than 6 collections, a 2X’s security deposit may be considered.

Applicants with poor credit scores and more than 6 collections will not be accepted.
Criminal History: A criminal report will be obtained for all applicants. A conviction, guilty plea or no-contest plea for any Felony shall be
grounds for denial of the rental application. Any offense that requires the Applicant to register as a sex offender will result in the denial of
the rental application. Pending charges will result in a denial of the application.
Any individual whose tenancy would constitute a direct threat to the health and safety of the public or other tenants or whose
tenancy would result in a substantial physical damage to the property of others will be denied tenancy.
The applicant has the right to dispute the accuracy of any credit/criminal report information provided to the landlord. Credit/Criminal
report inquiries should be directed to the credit bureau Experian, 1.888.397.3742 and/or email: [email protected]
PETS
Pets may be allowed at the discretion of the management. Except that un-neutered male cats are not allowed. If pets are accepted, the
applicant must pay a refundable pet deposit of $250 for the first animal and $125 for a second animal with a limit of two pets per unit.
The applicant must also sign a pet agreement form. Note that Oregon law requires all dogs to be vaccinated against rabies as early as
three months of age, and Multnomah County requires all cats to be vaccinated for rabies. Breed and weight restrictions apply.
OCCUPANCY LIMITS
Occupancy is based on the number of bedrooms in a unit. A bedroom is defined as a space within the premises that is used primarily for
sleeping, with at least one window and a closet for clothing. 2 persons are allowed per bedroom, plus 1 additional occupant per unit.
DISABLED ACCESSIBILITY
Circum Pacific Properties allows existing premises to be modified at the full and complete expense of the disabled person, if the
disabled person agrees to restore the premises (per fair housing guidelines) at their own expense to the pre-modified condition.
We require:

The applicant to seek the landlord’s written approval before making modifications

Reasonable assurances (in writing) that the work will be performed in a workmanlike manner.

Reasonable details regarding the extent of the work to be done.

Names of qualified contractors that will be used.

Appropriate building permits and the required licenses must be made available for inspection by landlord.

A deposit for restoration may be required. This deposit to be placed in an interest bearing account and will be used for
necessary restoration cost, not including normal wear and tear and non-required restoration (see fair housing guidelines).
We Do Business in Accordance With the Federal Fair Housing Law
It is illegal to discriminate against any person because of race, color, religion, sex,
handicap, familial status, or national origin.
rev. 7.11.14
page 2 of 2