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RE/MAX Kauai
Property Interested In:
Applicant Info
Marital Status?
Was your rent up to date?
Was your rent up to date?
Do you smoke?
Have you or any household member been arrested or convicted of any crime, or drug related activity?
Proposed Occupants
Income & Employment Data
Housing Assistance?
DSS Assistance?
Bank & Credit Loan Data
Personal References

Type your full name here to authorize

I authorize RE/MAX Kauai, Inc. to obtain and verify information about the income, assets, personal data & conduct of all products listed on my application. Sources of such information may include but are not limited to employers, social workers, welfare workers, landlords, resident/housing managers, parole officers, court and criminal records, drug treatment centers, clinics, physicians or police departments.


I hereby authorize consumer reporting agencies to provide you with consumers reports relating to me. I hereby give my permission for RE/MAX Kauai, Inc. to verify the above information. I understand that if any of the information provided is later found to be fraudulent, the landlord has the right to terminate my lease agreement immediately.


I have read the form and I understand that if I cause a financial loss to the Landlord that my name may be forwarded to all credit agencies and such information will be furnished to subscribers who have bona fide and legal need to make an inquiry. I also understand that causing a financial loss may limit my ability to obtain credit or to lease other dwelling untis.

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