Rental Application

Please call (501) 224-4111 prior to completing your application to verify property availability.  There is a $40 application fee required for processing your Rental Application.  In order to apply online, you must pay the application fee by debit or credit card below in order to submit your completed application.


RE/MAX Properties
Pavilion in the Park
8201 Cantrell Road
Suite 225
Little Rock, AR 72227
Address: Date Wanted:


Applicant's Name:DOB:SSN#:
Driver's License #:Applicant's Income:
Home #:Cell #:Work:
Email Address:Gender:M F Emergency#:
Other Tennants:DOB:Phone:
Applicant's Present Address:Landlord:
Yrs: Mos: Phone:
Applicant's Previous Address:Landlord:
Yrs: Mos: Phone:
Legal Marital Status:Married
Widowed Divorced


Applicant's Occupation:Employer/Contact:
Direct Supervisor:
Business Address:Employer's Phone#:
Applicant's Previous Employer:Previous Supervisor:
Phone Number:
Other's Tenants Occupation:Employer/Contact:
Employer's Phone:


May we contact the references below?Yes No
If not, why?
Bank Reference:Checking Savings
Someone other than a family member that is not living with you.
Personal Reference:Relationship:
Address:Phone Number:
Personal Reference:Relationship:
Address:Phone Number:
Relative/Emergency Contact (not residing with you):
1. Name:Relationship:
Home Phone #:Work Phone #:
Address:City:State: Zip:
2. Name:Relationship:
Home Phone #:Work Phone #:
Address:City:State: Zip:


OwnerMakeModelColorStateLicense #         State


How many pets?NameTypeGenderWeight      BreedColorAge
NOTE: Keeping of pet or animal requires consent of management, payment of applicable fee/deposits. In specific circumstances, certain animals may be kept for limited purposes pursuant to Landlord's policies, such as animals used for individuals with disabilities and official police dogs. For further details, please refer to the Landlord's pet and community policies.
Disclosures: The Civil Rights Act of 1968, as amended by the Fair Housing Act Amendments of 1988, prohibits discrimination in housing based on race, color, national origin, religion, sex, handicap, or familial status. The management of this property is committed to complying with the letter and spirit of the laws which provide an equal housing opportunity to all. The federal agency which administers compliance with the fair housing laws is the United States Department of Housing and Urban Development.
Any unanswered "yes" or "no" question shall result in the denial of your application.
Have you or any member of your household ever been convicted of or pled guilty or "no contest" to any felony?
Please check one of the following: Yes     No
Have you or any member of your household ever been convicted of or pled guilty or "no contest" to a sexual offense?
Please check one of the following: Yes     No
Have you or any member of your household ever been listed on a regsitry of sexual offenders?
Please check one of the following: Yes     No
Have you or any member of your household ever been convicted of or pled guilty or "no contest" to any drug related criminal offense?
Please check one of the following: Yes     No
If yes to any of the above questions, please explain, providing the location, date and nature of the offense:
INSURANCEOwner and Agent carry no insurance on the personal property of the tenants. They are only responsible for the dwelling. It is recommended that you retain rental insurance.
CREDITA credit report on applicant may be obtained by Leasing Agent on behalf of the Owner prior to execution of a lease. Applicant consents to the obtaining of such credit report.
I have read the foregoing, certify that the information herein is TRUE & CORRECT, that this application is submitted for the purpose of inducing approval of this application on my behalf.
By entering both my name and email address below (as authorized under the federal Electronic Signatures in Global and National Commerce Act of 2000), I authorize Landlord or agent for Landlord to verify any information contained herein. Any "yes" response to the personal and criminal history questions above, or any false statement on the application, will lead to the rejection of my application and/or immediate termination of my lease. Further, if I am subsequently involved in conduct which would result in a "yes" response to any of the questions set forth above (even after I sign the lease and take possession of the apartment or home), I understand that Landlord may terminate the Lease.


There is a $35 fee for processing your application. You must provide your credit or debit card information below to complete your online application.
Name on Card:Card No.Expiration: CVV:

Credit Card Merchant Services