Rental Application

Separate application required from each applicant age 18 or older.

Date and time received by landlord

Credit check fee Received

This section to be completed by landlord

Address of Property to Be Rented:
Rental Term: month-to-month lease from to
Amounts Due Prior to Occupancy
First month’s rent ..................................................................................................................... $
Security deposit ........................................................................................................................ $
Other (specify): $
TOTAL .............................................................. $

Applicant
Full Name—include all names you use(d):
Home Phone: Work Phone: Cell Phone:
Email: Fax:*
Social Security Number: Driver’s License Number/State:
Other Identifying Information:
Vehicle Make: Model: Color: Year:
License Plate Number/State:

Additional Occupants
List everyone, including children, who will live with you:
Full Name Relationship to Applicant

Rental History
First-Time Renters: Attach a description of your housing situation for the past five years.
Current Address:
Dates Lived at Address: Rent $ Security Deposit $
Landlord/Manager: Landlord/Manager’s Phone:
Reason for Leaving:
* By providing this fax number I agree to receive facsimile advertisements from the landlord or management company.
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Previous Address:
Dates Lived at Address: Rent $ Security Deposit $
Landlord/Manager: Landlord/Manager’s Phone:
Reason for Leaving:

Previous Address:
Dates Lived at Address: Rent $ Security Deposit $
Landlord/Manager: Landlord/Manager’s Phone:
Reason for Leaving:

Employment History
Self-employed applicants: attach tax returns for the past two years.
Name and Address of Current Employer:
Phone: ( )
Name of Supervisor: Supervisor’s Phone: ( )
Dates Employed at This Job: Position or Title:

Name and Address of Previous Employer:

Phone: ( )
Name of Supervisor: Supervisor’s Phone: ( )
Dates Employed at This Job: Position or Title:
Attach pay stubs for the past two years, from this employer or prior employers.

Income
1. Your gross monthly employment income (before deductions): $
2. Average monthly amounts of other income (specify sources): $
$
$
TOTAL: $

Bank/Financial Accounts
Account Number Bank/Institution Branch
Savings Account:
Checking Account:
Money Market or Similar Account:
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Credit Card Accounts
Major Credit Card: VISA MC Discover Card Am Ex Other:
Issuer: Account No.
Balance $ Average Monthly Payment $
Major Credit Card: VISA MC Discover Card Am Ex Other:
Issuer: Account No.
Balance $ Average Monthly Payment $

Loans
Type of Loan (mortgage, Amount Monthly
car, student loan, etc.) Name of Creditor Account Number Owed Payment

Other Major Obligations

Amount Monthly
Type Payee Owed Payment

Miscellaneous
Describe the number and type of pets you want to have in the rental property:
.
Describe water-filled furniture you want to have in the rental property:
.
Do you smoke? yes no
Have you ever: Filed for bankruptcy? yes no How many times
Been sued? yes no How many times
Sued someone else? yes no How many times
Been evicted? yes no How many times
Been convicted of a crime? yes no How many times
Explain any “yes” listed above:

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References and Emergency Contact
Personal Reference: Relationship:
Address:
Phone: ( )

Personal Reference: Relationship:

Address:
Phone: ( )

Contact in Emergency: Relationship:

Address:
Phone: ( )

Source
Where did you learn of this vacancy?

I certify that all the information given above is true and correct and understand that my lease or rental agreement
may be terminated if I have made any material false or incomplete statements in this application. I authorize
verification of the information provided in this application from my credit sources, credit bureaus, current and
previous landlords and employers, and personal references. This permission will survive the expiration of my tenancy.

Applicant Date

Notes (Landlord/Manager):
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 Consent to Contact References and Perform Credit Check

I authorize
to obtain information about me from my credit sources, current and previous landlords, e­ mployers, and personal
references, to enable to
evaluate my rental application.

I give permission for the landlord or its agent to obtain a consumer report about me for the purpose of this
application, to ensure that I continue to meet the terms of the tenancy, for the collection and recovery of any
financial obligations relating to my tenancy, or for any other permissible purpose.

Applicant Signature

Printed Name

Address

Phone Number

Date
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 Tenant References

Name of Applicant:
Address of Rental Unit:

Previous Landlord or Manager

Contact (name, property owner or manager, address of rental unit):

Date:

Questions
When did tenant rent from you (move-in and move-out dates)?
What was the monthly rent? Did tenant pay rent on time? Yes No
If rent was not paid on time, did you have to give tenant a legal notice demanding the rent? Yes No
If rent was not paid on time, provide details

Did you give tenant notice of any lease violation for other than nonpayment of rent? Yes No
If you gave a lease violation notice, what was the outcome?
Was tenant considerate of neighbors—that is, no loud parties and fair, careful use of common areas?

Did tenant have any pets? Yes No If so, were there any problems?

Did tenant make any unreasonable demands or complaints? Yes No If so, explain:

Why did tenant leave?

Did tenant give the proper amount of notice before leaving? Yes No
Did tenant leave the place in good condition? Did you need to use the security deposit to cover damage?

Any particular problems you’d like to mention?

Would you rent to this person again?

Other comments:
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Previous Landlord or Manager
Contact (name, property owner or manager, address of rental unit):

Date:

Questions
When did tenant rent from you (move-in and move-out dates)?
What was the monthly rent? Did tenant pay rent on time? Yes No
If rent was not paid on time, did you have to give tenant a legal notice demanding the rent? Yes No
If rent was not paid on time, provide details

Did you give tenant notice of any lease violation for other than nonpayment of rent? Yes No
If you gave a lease violation notice, what was the outcome?
Was tenant considerate of neighbors—that is, no loud parties and fair, careful use of common areas?

Did tenant have any pets? Yes No If so, were there any problems?

Did tenant make any unreasonable demands or complaints? Yes No If so, explain:

Why did tenant leave?

Did tenant give the proper amount of notice before leaving? Yes No
Did tenant leave the place in good condition? Did you need to use the security deposit to cover damage?

Any particular problems you’d like to mention?

Would you rent to this person again?

Other comments:
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Employment Verification
Contact (name, company, position):
Date: Salary $
Dates of Employment:
Comments:

Personal Reference
Contact (name and relationship to applicant):
Date: How long have you known the applicant?
Would you recommend this person as a prospective tenant?
Comments:

Credit and Financial Information

Notes, Including Reasons for Rejecting Applicant

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