Application To Rent Form
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1DISTINCT
2030 N. Pacific Ave, Ste A, Santa Cruz, CA 95060
Fax: 831.420.0202
Each Individual Occupant Who is Responsible for Rent Payments MUST
Complete a Separate Application Form
Application to Rent
EMAIL ADDRESS:
LAST NAME
FIRST NAME
MIDDLE NAME
SOCIAL SECURITY NUMBER
DATE OF BIRTH
DRIVER LICENSE NO.
STATE
HOME PHONE NUMBER
1. PRESENT HOME ADDRESS
CITY
STATE
ZIP CODE
LENGTH OF TIME
STATE REASON FOR MOVING
LANDLORD NAME
LANDLORD PHONE NO.
2. PREVIOUS HOME ADDRESS
CITY
STATE
ZIP CODE
LENGTH OF TIME
STATE REASON FOR MOVING
LANDLORD NAME
LANDLORD PHONE NO.
3. PREVIOUS HOME ADDRESS
CITY
STATE
ZIP CODE
LENGTH OF TIME
STATE REASON FOR MOVING
LANDLORD NAME
LANDLORD PHONE NO.
NAME
NAME
NAME
DESCRIBE EACH AND EVERY PERSON WHO WILL
OCCUPY THE PREMISES
IF YES PLEASE DESCRIBE
IF YES PELASE DESCRIBE
WILL YOU HAVE ANY LIQUID
WILL YOU HAVE ANY PETS?
FILLED FURNITURE?
PRESENT OCCUPATION
EMPLOYER NAME
HOW LONG WITH
PHONE
EMPLOYER
(
)
THIS EMPLOYER
NUMBER
ADDRESS
NAME OF
SUPERVISOR
PRIOR OCCUPATION
EMPLOYER NAME
HOW LONG WITH
PHONE
EMPLOYER
(
)
THIS EMPLOYER
NUMBER
ADDRESS
NAME OF
SUPERVISOR
1
1
1
NAME OF YOUR BANK
BRANCH OR ADDRESS
CURRENT GROSS INCOME
PER
WEEK
YEAR
CHECKING ACCT. #
1
1
$
SAVINGS
MONTH
PLEASE LIST ALL YOUR FINANCIAL OBLIGATIONS
(IF MORE CREDITOR USE ADDITIONAL SHEET OF PAPER)
NAME OF CREDITOR
ADDRESS
PHONE NUMBER
MONTHLY PAYMENT AMT.
(
)
(
)
(
)
IN CASE OF EMERGENCY, NOTIFY:
PHONE: (
)
CITY:
RELATIONSHIP:
1. MAKE
MODEL
YEAR
LICENSE #
LIST ALL AUTOMOBILES AND OTHER VEHICLES:
2 MAKE
MODEL
YEAR
LICENSE#
OTHER
HAVE YOU EVER FILED FOR BANKRUPTCY?
IF YES, DATE BK FILED
HAVE YOU EVER BEEN EVICTED OR ASKED TO MOVE?
Applicant represents that all the above statements are true and correct and hereby authorizes landlord/agent to verify the above items including, but not
limited to, the obtaining of a credit report and agrees to furnish additional credit references upon request.
The undersigned makes application to rent housing accommodations designated as:
address of:____________________________________________ Apt.No._____________________ City/State:_________________________
the rental for which is $____________________ per 1 Month 1 Week 1 Other ________and upon approval of this application agrees to sign a rental or
lease agreement and to pay all sums due, including required deposits, before occupancy
_________________________________
______________________________________
Date
Signature
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