Application To Rent

A PPLICATION TO RENT

Separate application requi red for each adult occupant (All sections must be completed)

Last Name ______________________________ First Name

Middle

Other name(s) known by in past:

Soc. Sec. # ______/_______/__________ Driver’s License #

Stat e

Date of Birth

/

/

Marital Status:

s ingl e marri ed div orc ed s eparat ed

( c i r c l e o n e )

Cell Phone ________________________

Cell Carrier _______________________ Email: _______________________________________

Home Phone ______________________

Work Phone ______________________ Facebook/Blog/Myspace:________________________

List all other persons who will be occupants under the age of 18:

Full Name

Age

Date of Birth

Soc. Sec. #

Relationship to you

Emergency Contact:

Relationship:

Phone(s):

E m a i l :

R e n t a l H i s t o r y :

C u r r e n t a d d r e s s

C i t y

S t a t e

Z i p

C u r r e n t a d d r e s s i s : p a r e n t ’ s h o m e

o w n h o m e

r e n t h o m e

r e n t a p a r t m e n t

s t u d e n t h o u s i n g

f r i e n d

L a n d l o r d ’ s n a m e

p h o n e (

)

Date In:

Date Out:

Monthly payment $

Reason for Leaving

P r e v i o u s A d d r e s s

City

State

Zip

P r e v i o u s a d d r e s s i s : p a r e n t ’ s h o m e

o w n e d h o m e

r e n t e d h o m e

r e n t e d a p a r t m e n t

s t u d e n t h o u s i n g

f r i e n d

L a n d l o r d ’ s n a m e

p h o n e (

)

Date In:

Date Out:

Monthly payment $

Reason for Leaving

E m p l o y m e n t :

P r e s e n t O c c u p a t i o n

E m p l o y e r N a m e

How Long?

Name of Supervisor

Phone # (

)

Address

City

State

Zip

Current Monthly Gross Income $

How often are you paid? (circle one) weekly bi-weekly semi-monthly monthly

P r i o r O c c u p a t i o n

E m p l o y e r N a m e

How Long?

Name of Supervisor

Phone # (

)

Address

City

State

Zip

Financial:

Name of Bank

Address

Account No.

Check all that apply: Checking

Savings

Visa

Loan

Credit Card Type

Bank/Issuer

Number

Expires _____/_____

List Financial Obligations:

C r edit or N am e

Address

Phone #

M o n t h l y P a y m e n t

Have you ever been arrested, accused, charged or convicted of any crime? No

Yes

If yes, please explain each crime in detail:

Have you ever filed for Bankruptcy? No

Yes

(If yes, please give date filed

, and in which state?

)

Has an eviction action ever been filed against you? No

Yes

(if yes, what is the status of the case?

Do you smoke?

Do you have any pets?

If yes, which breed and size?

App lican t re p rese n ts tha t a ll o f th e abo ve s ta te me n ts a re true and c o rrec t an d here by au th o rizes ve rifica tio n o f the abov e ite ms inc luding but not limited to

the ob ta in ing of credit re po rts and ag rees to furn ish add itional cred it re fe re nces on re que st. Applicant also affirms that all oc cupants of the leased

premises are and will be le gally residing in the United States.

All applications will be reviewed in the order received and judged

based on the above criteria. Owner does not discriminate on the basis

Applicant signature

Date

of race, color, religion, gender, national origin, disability, familial status

or source of income.