Country Club Villas Townhomes Online Screening Application

CAUTION: This is a Legal Form. You must be the Applicant to Sign This Form. The order will not be processed without the applicant’s signed authorization.

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Write your Full Legal Name (First, Middle, Last) EXACTLY as it appears on your Driver’s License or Passport.
Do Not Use a nickname, alias or abbreviation. If you have two last names, use them both.

Associated Services of Florida

Date *

Application Type *

Rental

Purchase

Purchase Price

Choose Which Association are you applying to? * 30 Thirty North Ocean CondominiumArbor Green HOACarmel Lakes No 6Catalina Bay at Monarch Lakes HOAFlagler First Condominium Association, Inc.Lake Arbor Village HOAIves Dairy TownhomesCountry Club Villas TownhomesThe Enclave at Mangonia ParkCross Creek II PatioPalm Beach Villas CondominiumShore Club CondominiumCarmel Lakes Condo No. 7Portofino HomeownersMariposa Isles at Monarch Lakes HOATropical Breeze TownhomesPark Layne TowersThe Edge on 20thThe Preserve at Bay Hill EstatesThe Gardens Residence at City PlaceThe Ambassador at Hamptons WestVineyards at Plantation CondominiumEastside Village of Oakland ParkHoneyplace HOAVillage Walk Master HOAQuatraine III Phase 1Northgate CondominiumCaptiva Condominium CParc VillageWestview Condominium Association No. 1Island Club TwoCedar Landing at Jacaranda Choose Which Association are you applying to?

Address of Property *

Where are you applying?

Lease Term *

Lease Start Date/Move In *

Lease End Date *

Monthly Rent *

Are you married and applying with your spouse? *

Yes

No

What is the name of your spouse? *

Email of your Spouse *

Applicant Information

First Name *

Middle Name

Middle name is required if you have one.

Last Name *

Use your full legal name as it appears on a driver’s license or passport. Do not use a nickname or alias.

Other Last Names Known By

Email Address *

Enter Your Email

Confirm Email Address *

Confirm Your Email

Driver’s License Number

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Telephone Number *

Residence History

Residence Type *

Rent

Own

Live with Family/Friend

Current Address *

Current Address

Current Address

Current Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

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Country

Monthly Rent Payment *

Monthly Mortgage Payment *

Name of Landlord/Property Management *

Telephone of Landlord/Property Management *

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Year

Vehicle Tag Number

Vehicle Tag State

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Year

Vehicle Tag Number

Vehicle Tag State

Employment

Are you Employed? *

Yes

No, I am unemployed, a student, homemaker or retired.

Employment Type: *

Full-Time

Part-Time

Name of Employer *

Occupation/Postion *

Telephone Number: *

Date Began Employment *

Monthly Salary $: *

Address of Employer:

Address of Employer:

Address of Employer:

Address of Employer:

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Country

Emergency Contact

Name of Emergency Contact: *

Relationship *

Telephone Number *

Email *

Personal References (No Family Members)

Name: *

Relationship *

Telephone Number *

Email *

Name: *

Relationship *

Telephone Number *

Email *

Realtor Contact Information

Name: *

Telephone *

Email *

Pets

Do you have a Pet? *

Yes

No

Does the Pet comply with the association requirements? *

Yes

No

How many pets do you have? *

1

2

3

What is the breed of Pet #1

What is the weight of Pet #1?

What is the breed of Pet #2

What is the weight of Pet #2?

What is the breed of Pet #3

What is the weight of Pet #3

Emotional Support Animal/Service Animal

Do you have an Emotional Support Animal/Service Animal *

Yes

No

How many ESA/Service Animals do you have?

1

2

What is the name of ESA #1 *

What is the breed of ESA #1 *

What is the weight of ESA #1 *

What is the age of ESA #1 *

What is the sex of ESA #1 *

What is the Tag Number of ESA #1 *

What is the name of ESA #2 *

What is the breed of ESA #2 *

What is the weight of ESA #2 *

What is the age of ESA #2 *

What is the sex of ESA #2 *

What is the Tag Number of ESA #2 *

Other Questions

Have you ever been convited of, plead guilty, or “no contest” to a crime that has or has not been expunged or removed from your record? *

Yes

No

Have you ever filed for bankruptcy, been foreclosed on, or been a defendant in a civil suit? *

Yes

No

Please explain *

Please explain *

List of Occupants Under The Age of 18

Name

Age

Name

Age

Name

Age

Fs718.116(c) If the unit is rented or leased during the pendency of the foreclosure action, the association is entitled to the appointment of a receiver to collect the rent. The expenses of the receiver shall be paid by the party which does not prevail in the foreclosure action. If the unit owner becomes delinquent in paying any monetary obligation due to the association, the association may make a written demand that the tenant pay the future monetary obligations related to the condominium unit to the association and the tenant must make such payment. The association may sue for eviction as if the association were a landlord if the tenant fails to pay a required payment to the association.

Disclosures *

I understand that my application, lease or rental agreement may be denied or terminated if I have made any material false or left incomplete statements in this application. I further state this form was signed by me and was not originated with fraudulent intent by me or any other person.

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