RENTAL APPLICATION AND VERIFICATION
*Non-Refundable Application Fee of $35.00 at time of application*
Name__________________________________________________ D.O.B.__________________________SS#__________________________
Marital Status ( ) Single ( ) Married
( ) Divorced
Spouse__________________________________________D.O.B.____________________________SS#_________________________________
Names of Occupants ______________________________________________________________________________________________________
Dates of Birth___________________________________________________________________________________________________________
Do you have pets?
( ) Yes (please specify) ( ) No
Auto Make & Vehicle License #____________________________________
Present Address_____________________________________Telephone#______________________Term of Occupancy______________________
Present Landlord____________________________________Address_______________________________Telephone_______________________
Reason for leaving present address:___________________________________________________________________________________________
Past Landlord (if within 2 years)____________________________Address___________________________Telephone_______________________
Email of Applicant:_______________________________________________________________________________________________________
TWO PERSONAL REFERENCES WITH CONTACT INFO.
Name: ________________________ Tel: ____________________
Name: _________________________
Tel: ______________________
EMERGENCY NOTIFICATION ADDRESS & PHONE#________________________________________________________________________
_______________________________________________________________________________________________________________________
Employment
Present
Employer
Address
Telephone
How Long
Gross Income
Applicant
______________________________________________________________________________________________________________________
Spouse
______________________________________________________________________________________________________________________
Previous
Applicant
______________________________________________________________________________________________________________________
Spouse
_______________________________________________________________________________________________________________________
Are you presently receiving: Welfare ( ) Yes ( ) No Unemployment ( ) Yes ( ) No
Financial
Have you had accounts with the following local utility companies?
Gas
Electric
Telephone
Water
Bank Name_________________________________Address_________________________________________Telephone#____________________
Checking Acct #________________________________________Savings Acct#__________________________________________
Have you ever been evicted [ ]No [ ] Yes,_________________________________________________________________________
Have you ever been convicted of a felony [ ] No [ ] Yes, ______________________________________________________________
ENDORSEMENT:
Non-Refundable Application Fee: I understand that the application fee is not refundable for any reason. In compliance with Fair Credit Reporting Agency Act, this is to
inform that a credit investigation involving statements made on this application for tenancy will be initiated. I/We certify to the best of my/our knowledge, all
statements are true and complete. I/We further authorize you to obtain reports, character reports, civil and/or criminal records, and rental history as needed to verify all
the information to put forth in this application or a copy thereof. I/We understand that false, fraudulent or misleading information may be grounds for denial of tenancy.
Date______________________________________Signature______________________________________________________________________
_________________________________________
Date______________________________________Signature________________________