P.O. Box 3401
Shreveport, Louisiana 71133
Phone:318-621-9263
Fax: 318-636-4914

Rental Application
Membership Application
Pines Road, LLC
P.O. Box 3401
Shreveport, LA 71133
Toll Free: 800-564-2211
Office: 318-219-5587
Apartment Information
We offer 2, 3, and 4 bedroom Homes at affordable rates
Rent: $
 
Credit Check: $25
Move in Date: yyyy-mm-dd
Applicant Information
First Name:
Last Name:
Date of Birth:
Social Security:
Phone:
Cell Phone:
License:
 
Will any children under age 18 be living with you? Yes or No (Circle One)
How Many:
Ages:
Current Address
Address:
 
City:
State:
ZIP Code :
Own or Rent (Please Circle):
Monthly Payment or Rent: $
Landlord:
Phone:
Start Date:
End Date:
Reason for Leaving:
 
Previous Address
Address:
 
City:
State:  
ZIP Code :
Own or Rent (Please Circle):
Monthly Payment or Rent: $
Landlord:
Phone:
Start Date:
End Date:
Reason for Leaving:
 
Employment Information
Current Employer:
 
Position:
 
Manager:
Phone:
Address:
 
City:
State:
ZIP Code :
Start Date:
End Date:
Monthly Pay $
 
Personal References
Name:
 
Relationship:
Phone:
Name:
 
Relationship:
Phone:
Banking Information
Bank:
 
Acct:
Amount: $
Bank:
 
Acct:
Amount: $
Automobile Information
Make & Model:
Plate:
Make & Model:
Plate:
Additional Income
Income Source:
Amount: $
Verify with:
Phone:
Additional Information
Have you ever been convicted of a crime? Yes or No (Circle One)
Describe and Date Each One:
 
Have you ever been evicted, declared bankruptcy or had a judgement? Yes or No (Circle One)
Describe and Date Each One:
 
Co-Applicant/Spouse Information
First Name:
Last Name:
Relationship to Applicant:
 
Date of Birth:
Social Security:
Phone:
Cell Phone:
License:
 
Current Address
Address:
 
City:
State:
ZIP Code :
Own or Rent (Please Circle):
Monthly Payment or Rent: $
Landlord:
Phone:
Start Date:
End Date:
Reason for Leaving:
 
Previous Address
Address:
 
City:
State:
ZIP Code :
Own or Rent (Please Circle):
Monthly Payment or Rent: $
Landlord:
Phone:
Start Date:
End Date:
Reason for Leaving:
 
Employment Information
Current Employer:
 
Position:
 
Manager:
Phone:
Address:
 
City:
State:
ZIP Code :
Start Date:
End Date:
Monthly Pay $
 
Personal References
Name:
 
Relationship:
Phone:
Name:
 
Relationship:
Phone:
Banking Information
Bank:
 
Acct:
Amount: $
Bank:
 
Acct:
Amount: $
Automobile Information
Make & Model:
Plate:
Make & Model:
Plate:
Additional Income
Income Source:
Amount: $
Verify with:
Phone:
Additional Information
Have you ever been convicted of a crime? Yes or No (Circle One)
Describe and Date Each One:
 
Have you ever been evicted, declared bankruptcy or had a judgement? Yes or No (Circle One)
Describe and Date Each One:
 
I Sgree to the following Statement:
I represent that the information provided in this application is true, complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of information is grounds for eviction.
I Agree to the following statement:
I understand that the information provided might be used by the Hochstadters (Landlord) to determine whether to accept this application. I authorize the Hochstadters to verify all the information given in this application, including past rental information, personal references and employment information provided. I authorize the Hochstadters to obtain a current credit and criminal background check.
I Agree to the following Statement:
I understand that this application is not a rental agreement and that this application does not create any obligation on the Hochstadters.

The undersigned represent that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation or omission of information is grounds for eviction.
Applicant
Print Name:
 
Signature:
Date:
Co-Applicant/Spouse
Print Name:
 
Signature:
Date: