214 Pioneer Pkwy W Springfield, OR 97477 541-683-6166

FOR OFFICE USE ONLY:
214 Pioneer Pkwy W
Springfield, OR 97477
541-683-6166
Rec’d: _________________
ID Check: ______________
APPLICATION FOR ADDRESS: __________________________________________________________________
FAILURE TO FILL-IN ALL BLANK LINES WILL CONSTITUTE AN INCOMPLETE APPLICATION WHICH MAY BE DENIED. IF ANY LINES ARE
NOT APPLICABLE TO YOUR SITUATION, PLEASE WRITE “N/A” ON THOSE BLANK LINES.
RENTERS’ INSURANCE: Acorn Property Management may require applicants to obtain Renters’ Liability Insurance in the amount
of $100,000 per occurrence. Renters’ Insurance obtained under this requirement must be maintained in force throughout the duration
of your tenancy. Failure to maintain the required Renters’ Insurance is grounds for termination of your tenancy. Proof of required
Renters’ Insurance must be produced to Acorn Property Management prior to taking occupancy of the rental.
Renters’ Insurance in the amount of $100,000 per occurrence is required:
(If left unmarked, no Renters’ Insurance is required.)
YES
NO
In those instances where Acorn Property Management does not require Renters’ Insurance, we strongly recommend you obtain this insurance
anyway. The cost of Renters’ Insurance is frequently less than $15/month, can usually be easily obtained through your auto insurance agent (often at
a discount), and protects you against the catastrophic cost of a liability claim or loss of your personal property.
SMOKING ON THE PROPERTY: SMOKING IS PROHIBITED EVERYWHERE ON THE PROPERTY AT ALL TIMES, UNLESS MARKED BELOW:
SMOKING IS PERMITTED OUTSIDE THE UNIT ONLY. SMOKING IS PROHIBITED INSIDE THE UNIT AT ALL
TIMES
NAME ______________________________________________________________ MIDDLE INITIAL ___________________
SOCIAL SECURITY NO. _________________________________________________ DATE OF BIRTH _________________
DRIVER'S LICENSE/GOVT ISSUED ID#
STATE _____
CURRENT PHONE (_____)_____________________
E-MAIL ADDRESS ____________________________________
TOTAL NUMBER OF PERSONS TO OCCUPY THE UNIT ___________
RENTAL HISTORY – PRESENT AND FORMER RENTAL HISTORY – MINIMUM OF LAST THREE LANDLORDS, MUST TOTAL AT LEAST THREE
YEARS (may attach additional sheet of paper, if necessary) :
PRESENT ADDRESS: (Incl. City, State & Zip) __________________________________________________________________________________
MOVE-IN DATE: ________________ DATE VACATED: _________________
PRESENT LANDLORD:
NAME
PHONE (____)_____________________
ADDRESS ______________________________________________________________________________________
FORMER ADDRESS: #1 (Incl. City, State & Zip) ________________________________________________________________________________
MOVE-IN DATE: ________________ DATE VACATED: _________________
FORMER LANDLORD #1:
NAME
____________________
_______
PHONE (_____)____________________
ADDRESS ______________________________________________________________________________________
FORMER ADDRESS: #2 (Incl. City, State & Zip) ________________________________________________________________________________
MOVE-IN DATE: ________________ DATE VACATED: _________________
FORMER LANDLORD #2:
NAME
____________________
_______
PHONE (_____)____________________
ADDRESS ______________________________________________________________________________________
EMPLOYMENT: FIRM
______ CONTACT NAME: _____
PHONE (_____)____________________
ADDRESS? (Incl. City, State & Zip) ___________________________________________________________________________________________
HIRE DATE?
PREV. EMPLOYER
POSITION _____________________________ GROSS MONTHLY PAY __________________
HIRE DATE: __________________ END DATE: _____________________
PHONE (____)_________________________ CONTACT NAME: ___________________________________
OTHER SOURCES OF INCOME: (including housing assistance)
SOURCE OF INCOME _____________________________ FREQUENCY __________________ AMOUNT OF PAYMENT __________________
SOURCE OF INCOME _____________________________ FREQUENCY __________________ AMOUNT OF PAYMENT __________________
SOURCE OF INCOME _____________________________ FREQUENCY __________________ AMOUNT OF PAYMENT __________________
BANK ACCOUNTS
NAME _________________________________ ACCT TYPE ____________ ACCT # __________________________ BALANCE ________________
NAME _________________________________ ACCT TYPE ____________ ACCT # __________________________ BALANCE ________________
NAME _________________________________ ACCT TYPE ____________ ACCT # __________________________ BALANCE ________________
IN CASE OF EMERGENCY NOTIFY: (cannot be co-applicant)
NAME
ADDRESS/CITY/STATE/ZIP: _________________________________________
AREA CODE & TELEPHONE: (
)
LIST ALL OUTSTANDING DEBTS:
NAME
OUTSTANDING AMOUNT
MONTHLY PAYMENT ________________
NAME
OUTSTANDING AMOUNT
MONTHLY PAYMENT ________________
NAME
OUTSTANDING AMOUNT
MONTHLY PAYMENT ________________
DO YOU INTEND TO BRING ANY ANIMAL(S) ONTO THE RENTAL PROPERTY?:
YES _________ NO ___________
If yes, are any of the animal(s) an assistance animal? YES _________ NO ___________
We welcome the opportunity to consider any reasonable accommodation requests made to Acorn Property Management for assistance animals in any
of our rental properties. To obtain a reasonable accommodation form, please contact the Acorn Property Management office.
PETS: YES _________ NO ___________
TYPE
____
Breed(s) ________________________________________ AGE ______________ COLOR ________________________
TYPE
____
Breed(s) ________________________________________ AGE ______________ COLOR ________________________
***Unauthorized pets, including “visiting” pets, are grounds for immediate eviction and/or additional fees as provided below***
AUTOMOBILES:
YR _________ MAKE _____________________ LIC. #_______________ STATE ________________________
YR _________ MAKE _____________________ LIC. #_______________ STATE ________________________
OTHER VEHICLES __________________________________________________________________________________________
ARE YOU A SMOKER: YES _________ NO ___________
DO YOU UNDERSTAND YOU ARE APPLYING FOR A NO SMOKING PROPERTY? YES _________ NO ___________
DO YOU CURRENTLY HAVE RENTERS’ INSURANCE: YES _________ NO ___________
Why are you vacating present place of residence? __________________________________________________________________
Has a former landlord ever filed any kind of legal action against anyone on this application? _________
Why? __________________________________________________
Current disposition? __________________________________
Are you currently being investigated or have you ever been charged or convicted of any crimes, felony or misdemeanor? _________
If yes, what? __________________________________ When? ___________________ Current disposition? ________________________________
what? __________________________________ When? ___________________ Current disposition? ________________________________
what? __________________________________ When? ___________________ Current disposition? ________________________________
***How did you hear about the rental? (Acorn website? Craigslist? Other website? Radio? Sign in yard? From a friend?)
_________________________________________________________________________________________________________________________
ACORN PROPERTY MANAGEMENT APPLICATION SCREENING CRITERIA AND FEE DISCLOSURE
APPLICATION POLICY: We require one application for each adult, 18 years or older, and a non-refundable application fee of $40.00 each
(payment of cash, money order or cashier’s check. No personal checks, please.). We require government-issued photo identification for each
adult applicant, and we screen each adult individually. We do not accept incomplete applications. We review completed applications in the order
in which they are received. If, after a good faith effort, we are unable to verify information on your application or if an applicant fails to pass any
one step, the application process will be terminated and we will move on to the next application.
APPLICATION REQUIREMENTS: We may obtain a credit report and criminal history report, and may verify rental history and employment/
income history. We may also run a credit check, criminal history check, and income verification on co-signers (if applicable).
PREVIOUS RENTAL HISTORY: We require three years verifiable positive rental history or home ownership and no previous history of eviction
within the last five years. (We do not consider evictions which took place five years or more ago, nor do we consider evictions which resulted in a
dismissal or a general judgment for the applicant.) We reserve the right to contact all current and prior landlords for a rental reference, including
those landlords involved in an applicant’s eviction five or more years ago.
INCOME REQUIREMENTS: The total gross monthly income must be at least three times the amount of the monthly rent. If you have shared a
household for a year or more, you may combine income to meet this requirement. We must be able to verify your income. Verifiable income may
mean, but is not limited to: employment paychecks, bank accounts, alimony/child support, trust accounts, Social Security, unemployment, welfare,
grants/loans, and housing assistance.
CREDIT REQUIREMENTS: We may use credit reports to verify the accuracy of the information provided by applicants. You must list all existing
credit and debts on your application. A negative credit report may result in an application denial. Negative reports include, but are not limited to:
late payments, collections, judgments, total debt load and bankruptcy.
CRIMINAL HISTORY: Criminal convictions or pending charges which may result in an application denial include, but are not limited to: drugrelated crimes, person crimes, sex offenses, any crimes involving financial fraud (including identity theft or forgery), or any other crime if the
conduct for which the applicant was convicted or charged is of a nature that would adversely affect the property of the landlord or a tenant(s) or
the health, safety or right of peaceful enjoyment of the premises of the residents, the landlord or the landlord’s agent.
All applicants may submit a supplementary written explanation with their application if there are extenuating circumstances which require
additional consideration by Acorn Property Management.
CO-SIGNER REQUIREMENTS: If an applicant is unable to meet one or more of our screening requirements, a co-signer may be required. A cosigner must complete a co-signer agreement and have verifiable gross monthly income of at least three times the amount of the monthly rent. A
co-signer agreement is binding for the entire term of the tenancy and shall only terminate when the tenant’s debt obligation to Acorn Property
Management terminates. We reserve the right to notify the cosigner about any information related to the tenancy which we deem necessary.
REASONABLE ACCOMMODATIONS: If you have a disability and need special features (such as visible emergency alarms, lowered kitchen
counters/sinks, grab bars in bathroom, ramps, etc.), or a modification of Acorn rules, policies, or procedures, or a change in the way we
communicate with you or give you information, you may ask for this kind of change, which is called Reasonable Accommodation/Modification. You
may pick up a Reasonable Accommodation/Modification form at the Acorn office. All animals approved to live in a rental property under a
reasonable accommodation request must be vaccinated and city/county licensed and proof of each must be produced to the Acorn Property
Management office.
GENERAL REQUIREMENTS:
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If an applicant is unable to meet one or more of our screening requirements, an additional security deposit and/or co-signer may be required.
Any information provided that is incomplete, inaccurate or falsified may be grounds for denial of the application or subsequent immediate
termination of tenancy.
Applicants may be rejected on the demeanor in which they treat the employees of Acorn Property Management or other parties present.
Pets may be allowed at some properties but must be pre-approved in advance. We do not allow Chows, Pit Bulls, American Staffordshire
Terriers, Presa Canarios, Rottweilers, Akitas, Doberman Pinschers, wolf-hybrids, or any mixes thereof, or any exotic animals (as deemed by
Acorn Property Management) as pets. We do not allow any animal that has previously caused harm or bitten a person or another animal as
pets. We do not allow pets less than 1 ½ years of age without written pre-approval. We charge a $400.00 additional security deposit per pet
for the first pet and $200.00 additional security deposit for each pet thereafter. We also charge $20.00 per month increased rent for the first
pet and $15.00 per month increased rent for each pet thereafter. All pets must be spayed/neutered, vaccinated, insured by renters’ insurance
(if required at this rental unit), city/county licensed, and proof of each must be produced prior to a pet moving into the rental property.
Unless otherwise specified in the rental agreement/fixed term lease or its addendum, tenant(s) are responsible for maintenance of the yard in
the like manner in which it was received, including properly cultivating, weeding, mowing, caring for and adequately watering the lawn,
shrubbery and grounds. If the yard is not maintained in a neat and reasonable manner to Acorn Property Management’s satisfaction, a
professional service will be utilized and the cost billed to the tenant(s).
The rental unit for which you apply may have been built prior to 1978 and, therefore, may contain Lead-Based Paint. If the unit for which you
apply was built prior to 1978, you will be provided with a Lead-Based Paint Disclosure form and an EPA brochure entitled “Protect Your Family
From Lead in Your Home”. Please let us know right away if you have any questions about Lead-Based Paint and the rental process, or for more
information on the web, log-on to epa.gov/lead or click on the United States Environmental Protection Agency link on the acornpm.net
website homepage.
If you believe you will not meet one or more of our application screening guidelines, we welcome you to submit your application for
consideration anyway. To provide further explanation about why you do not meet one or more of the screening requirements, feel free to
make notes on the rental application or attach additional paperwork, as necessary.
ACORN PROPERTY MANAGEMENT ACCEPTANCE POLICY:
Once approved and offered the property, applicants have until 4:00 pm of the following day to accept. If applicants do not respond within that
time period, we will move on to the next application. The next step for the approved applicant is to bring in the security deposit in the form of a
cashier’s check or money order within 24 hours. Rent begins the day a security deposit is paid and a Deposit to Hold signed. Under no
circumstances will a rental property be taken off the market or held without rent being paid. (If a co-signer is required, the applicant will at this
time be given a co-signer agreement, which the co-signer must complete in the presence of a notary public and returned to Acorn; the process will
continue once this original document is received.). The applicant will at this time call utility companies to set up any applicable utilities in his/her
own name. An appointment will then be set for signing the rental agreement, typically the next business day.
Possession of the property will be given to the new tenant at the time of signing the rental agreement. All documents must be signed and
dated, and all terms agreed to. No “negotiations” will be granted. The tenant will also at this time pay prorated rent in the form of a cashiers’ check
or money order for the month of move-in. All money must be paid up front; no payment plans without prior approval will be allowed. At the time
all of these steps are complete, the tenant will receive keys to the rental unit and be allowed to move-in. The move-in process is now complete and
copies of all signed paperwork will be sent to the email address listed here-in. After move-in, tenant agrees to allow regular inspections.
Fees to be aware of after you take possession:
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Repairs necessitated by tenant(s)' negligence or abuse shall be billed to tenant(s) at the rate of not less than $45.00 per hour plus any other
expenses incurred. Failure to pay within 30 days shall be grounds for eviction.
Unauthorized pets are grounds for immediate eviction and/or additional fees as provided below. “Visiting” pets are considered
unauthorized pets.
Late fee: Any monies not received by 11:59 pm on the 4th day of the month in which they are due will result in a $75.00 late fee.
Returned Check Fee: There will be a returned check fee of $35.00 charged for each returned check in addition to actual bank
charges/penalties incurred by owner/agent. Should this cause funds to be collected later than the end of the 4th day of the month in which
they are due, there will also be a $75.00 late fee assessed.
Owner/Agent certifies that the rental unit is equipped with smoke alarm(s) and carbon monoxide detector(s) as required by ORS 90.479.
Owner/Agent certifies and tenant(s) acknowledges that the smoke alarm(s) and carbon monoxide detector(s) are in good working order at
this time. Tenant(s) acknowledges they are responsible for testing the smoke alarm(s) and carbon dioxide detector(s) no less than once
every six months and must notify manager immediately in writing of any operating deficiencies. Any smoke alarm or carbon monoxide
detector that is tampered with, disabled or not maintained by tenant(s) in good working order is subject to a $250.00 fee per alarm per
occurrence (unless the State Fire Marshal assesses the tenant a civil penalty for this conduct.)
Early termination of a fixed term lease shall be charged one and one-half times the monthly rent or actual damages, as determined by Acorn
Property Management at their discretion at the time of accounting.
Any monies owed by tenant(s) may be consigned to a collection agency, small claims court or circuit court. Tenant(s) expressly authorizes
Acorn Property Management, its agents, and/or the property owner the right to collect any and all costs, fees, expenses, charges and
incurred interest associated with the attempt to collect and/or the collection of any debts or monies owed under this contract. Tenant(s)’
financial obligation under this contract expressly includes the actual debt, and all other costs, fees, expenses and charges (including
financial expenses related to the collection activity of a Collection Agency), specifically including those in excess of the actual
debt. Interest on said debt to be charged at a rate of ten percent compounded monthly.
A fee of $50 per occurrence or $50 plus 5% of the current rent for subsequent same or similar violations will assessed for the following
violations:
Late payment of utilities or service charges
Failure to clean up pet waste from part of the premises other than the dwelling unit
Failure to clean up garbage, rubbish or waste from part of the premises other than the dwelling unit
Parking violations (including parking on the lawn) and/or improper use of vehicles on the premises
Smoking in a non-smoking area
Unauthorized pet(s) (including “visiting” pet(s))
Carpet Cleaning:
1. Owner/Agent had the carpets, if any, cleaned or shampooed using specialized equipment after the previous tenancy before the current
tenant(s) took possession. The landlord may deduct the cost of carpet cleaning regardless of whether the tenant cleans the carpet before
delivery of possession of the premises.
I certify the above information is correct and complete and hereby authorize you to make any and all inquiries you feel
necessary to evaluate my tenancy. I understand and accept the screening criteria and fee disclosure. I understand that
anything found to be untrue may result in an immediate rejection of this application and would be grounds for immediate
termination if a rental agreement has been entered into.
No marijuana, medical or otherwise, may be grown, stored or consumed on the premises without the prior consent of management.
Applicant Signature _________________________________________________________
Applicant Name ____________________________________________________________
Date: _____________________
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