Oregon Rental Application Page 3
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4Move In Date ______________ Move Out Date ______________ Rent $__________________
Owner/Agent _________________________________________Phone (
) _____________
Reason for Leaving _____________________________________________________________
CREDIT HISTORY:
Have you every filed bankruptcy?
Yes ___________ No ___________
Have you ever been evicted from a rental residence?
Yes ___________ No ___________
Are you a party to any lawsuits?
Yes ___________ No ___________
Have you had any late rental payments in the last year?
Yes ___________ No ___________
Are there any judgments against you?
Yes ___________ No ___________
If you answered yes to any of the above questions, please explain
_____________________________________________________________________________
REFERENCES:
Bank References
Bank Name ___________________________________________________________________
Account Type _________________ Account No. _____________________________________
Bank Name ___________________________________________________________________
Account Type _________________ Account No. _____________________________________
Credit References
Name ____________________________________________ Phone (
) __________________
Name ____________________________________________ Phone (
) __________________
Name ____________________________________________ Phone (
) __________________
By my signature below, I represent that all of the information that I have disclosed in this Oregon Rental
Application is true, accurate, and complete. I acknowledge that all of the information I have disclosed is
material and Landlord is relying on the information to decide whether to grant or deny this Application.
NAME _________________________________________ DATE ________________________
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