Louisiana Rental Application Form
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1Louisiana Rental Application
Applicant Information
Name:
Phone:
Date of birth:
Dr License:
Current address:
Contact:
Phone:
Monthly payment or rent:
How long?
☐
☐
Own
Rent (Please check)
Previous address:
Contact:
Phone:
Monthly payment or rent:
How long?
☐
☐
Owned
Rented (Please check)
Previous address:
Contact:
Phone:
Employment Information
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
Position:
Annual income:
☐
☐
Hourly
Salary (Please check)
Emergency Contact
Name of a person not residing with you:
Address:
City:
State:
ZIP Code:
Phone:
Relationship:
Co-applicant Information
Name:
Phone:
Date of birth:
Dr. License:
Current address:
Child:
Child:
Child:
(If different)Previous address:
Contact:
Phone:
Monthly payment or rent:
How long?
☐
☐
Owned
Rented
(Please check)
Co-applicant Employment Information
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
Position:
Annual income:
☐
☐
Hourly
Salary (Please check)
References
Name:
Address:
Phone:
I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this
application.
Signature of applicant:
Date:
Signature of co-applicant:
Date:
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Form R-1061 - Application For Direct Payment Of Lease/rental Tax To The Louisiana Department Of Revenue
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Form R-1061-l - Application For Authority To Remit Lease/rental Sales Taxes Directly To The Louisiana Department Of Revenue
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Related Categories
Parent category: Business