Rental Application Page 3
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5Miscellaneous
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 property
Do you smoke?
Yes
No
Have you ever: Filed for bankruptcy?
Yes
No
# Times
Been sued?
Yes
No
# Times
Sued someone else?
Yes
No
# Times
Been evicted?
Yes
No
# Times
Been convicted of a crime?
Yes
No
# Times
Explain any “yes” listed above:
Reference 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?
Certification of Information
I certify that all of 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 and/or profile
reporting agencies, current and previous landlords and employers, and personal references. This permission will survive
the expiration of my tenancy.
I agree to pay a nonrefundable charge of $25.00 to process the application. All applications are subject to approval and
acceptance of the Lessor or authorized agent. Each occupant and cosigner 18 years and older must fill out a separate
application.
Once an application is approved, the Security Deposit must be paid within 48 hours and all documents signed in order
to hold the availability of the dwelling unit. In addition, utilities must be transferred into the Lessee’s name before
the move-in date.
If an application to rent is withdrawn by the applicant or co-applicant after it has been approved, a prorated portion of
the security deposit may be retained by Lessor as a per diem charge for the number of days the dwelling was taken off
the market.
Applicant Signature
Date
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