Application To Rent Form (Page 2 of 2) in pdf

Vehicle License Plate Number 2: _____________________ State: ___________

Credit References (list bank, credit union, charge accounts, or other credit references.)

1. ______________________________________________________________________________

2. ______________________________________________________________________________

Personal References (list 2 personal references not related to you).

1. Name: ________________________________________ Phone: (________)-________-________

Street: ___________________________ City: _______________________ State: _______________

2. Name: ________________________________________ Phone: (________)-________-________

Street: ___________________________ City: _______________________ State: _______________

Have you ever been evicted as a tenant? Yes_________ No ______

Have you ever been convicted of a criminal offence? Yes____ No____ (If yes, what? ____________________)

Number of adults to occupy rental unit: _______ Number of children under 18 to occupy rental unit: ________

Please list all occupants:

_______________________________________________________________________

(list any additional occupants on the back of this form)

Number of pets: __________ Type of pets: _____________________________________________________

In case of an emergency please notify: __________________________ Phone: (_______)-________-________

Complete Address: street__________________________city________________state_______zip___________

TENANCY WILL BE DENIED if any information is misrepresented on this application. If misrepresentations are

found after the rental agreement is signed, your rental agreement will be terminated.

This is to advise that I the undersigned hereby authorize _____________________________________ the

person or firm to whom my application has been submitted, to obtain a consumer credit report, to conduct a

criminal record search, an eviction search and to make any other inquiries as deemed necessary in determining

eligibility for tenancy and assessing credit worthiness. I understand that the information set out in the rental

application form may be used for purposes of responding to emergencies, ensuring the orderly management of

the tenancy, complying with legal requirements and for collection purposes should rent be left owing or rental

property damaged at termination of lease or end of tenancy. I have also received a copy of the FCRA Summary of

Rights and understand it's contents.

Applicant’s Signature: _______________________________ Date: _________________________________

Co-Applicant’s Signature: ____________________________ Date: _________________________________

This information is deemed to be private and confidential.

American Application to Rent

October 2004

page 2 of 2

Application To Rent Form Page 2