Rental Application
Amounts Due Prior to
Occupancy
First Month’s Rent $975.00
Security Deposit $1100.00
Total $2075.00
Full Name __________________________________________________________________
Home Phone ______________________Work Phone________________________________
Social Security Number________________________________________________________
Drivers License Number/State __________________________________________________
Vehicle Make/Model/Year __________________License Plate Number ________________
Additional Occupants-Relationship-cosignor (yes/no)
__________________________________________________________________________
__________________________________________________________________________
___________________________________________________________________________
Rental History
Current Address ______________________________________________________________
Dates Lived at Address__________________ Reason for Leaving _______________________
Landlord/Manager_______________________ Phone Number _________________________
Previous Address ______________________________________________________________
Dates Lived at Address__________________ Reason for Leaving _______________________
Landlord/Manager_______________________ Phone Number __________________________
Employment History
Name and Address of Current Employer_____________________________________________
Name of Supervisor________________________ Phone Number_________________________
How Long with This Employer ________________ Position or Title ______________________
Name and Address of Previous Employer___________________________________________
Name of Supervisor________________________ Phone Number_________________________
How Long with This Employer ________________ Position or Title ______________________
Income Information
Gross Monthly Employment Income ________________________________________________
Average Monthly Amounts of Other Income (specify) __________________________________
Total Monthly Household Income _________________________________________________
Credit and Financial
Information
Checking Account (Bank/Account Number) ________________________________________
Savings Account (Bank/Account Number) _________________________________________
Credit Cards (Bank/Account Number) _____________________________________________
Other Major Obligation (Listed on Credit Report) _____________________________________
Have you ever: Filed for Bankruptcy? Yes/no Been sued? Yes/no Been evicted? Yes/no
If yes, explain _________________________________________________________________
Do you own pets? Yes/no Do you smoke? Yes/No Do you have water filled furniture? Yes/NO
Other Information on Credit Report You Wish to Disclose _____________________________
_____________________________________________________________________________
______________________________________________________________________________
Personal References
and Emergency Contact
Personal Reference ___________________________ Relationship _____________________
Address ____________________________________ Phone Number _____________________
Personal Reference ___________________________ Relationship _____________________
Address ____________________________________ Phone Number _____________________
Contact in Emergency ___________________________ Relationship _____________________
Address ____________________________________ Phone Number _____________________
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 misrepresentation in this application. I authorize verification of any of the information and references provided in this application. In addition to all sums due prior to occupancy, I agree to pay a nonrefundable fee of $25.00, which shall be used to obtain a report on my credit from a credit reporting agency.
Date ______________________ Signature ___________________________________