Residential Rental Application Form
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1Check One: Investigative Reports: Co-Signer _____ Mini ______ Super-Mini _____ Orca ______ Killer Whale ______
Non-Refundable
_________
$
Screening Fee
RESIDENTIAL RENTAL APPLICATION / EACH ADULT MUST FILL OUT SEPARATE APPLICATION
Address of Rental Property:______________________________________Unit #__________________Rent Amount________
Applicant’s Complete Name:____________________________________________ Date of Birth:_______________________
SSN#___________________________________________DL# / State Issued: ______________________________________
Tel#__________________________________ Email Address: __________________________________________________
________________________________________________________________________________________
Other Occupant’s Name, Age & Relationship
:
√ √ √ √
Complete Every Item On Application. Incomplete and/or Inaccurate Information May Result in Process Delay or Denial of Tenancy.
CURRENT ADDRESS (Required Entry)
PRIOR ADDRESS (Required Entry)
Street_________________________________________________
Street________________________________________________
City______________________State__________Zip___________
City____________________State________Zip______________
Apt # _________Name of Apts_____________________________
Apt #________Name of Apts ____________________________
How Long(Mo/Da/Yr)From_______________To______________
How Long (Mo/Da/Yr) From_____________To______________
Pymts / Rent Pd To__________________________Amt ________
Pymts / Rent Pd To_________________________Amt________
Landlord/Mgmt Co.______________________________________
Landlord/Mgmt. Co____________________________________
Address_______________________________________________
Address______________________________________________
Tel#_____________________________Rent/Own/Lease________
Tel#__________________________ Rent/Own/Lease________
√ √ √ √
Current Employer________________________________________Tel#________________________Supervisor______________
Dept / Attached to
Occupation _____________________________________Rank __________________
Hire Date_____________________________Monthly Salary________________________Full Time __________ Part Time__________
Address
Suite
City________________________State/Zip___________
√ √ √ √
Prior Employer________________________________________________________Tel#__________________________________
Dept / Attached to
Occupation _____________________________________Rank __________________
Hire Date_____________________________Monthly Salary________________________Full Time __________ Part Time__________
√
Additional Income (Interest,Child Support,Etc)_________________________________________________________________________________
√
Bank____________________________Acct#_________________________________ Branch ________________Tel#_______________________
√
Pets? Yes _____ No _____ If yes, number, size, and type(s) _____________________________________________________________________
√
Disability status and require special accommodations? ____________________________________________________________________________
HAVE YOU OR ANY OTHER HOUSEHOLD MEMBER:
Ever been evicted or refused to pay rent? Yes _____ No _____
Ever been Charged or Convicted of a Crime? Yes _____ No _____
If yes to any of the above, give details: What is the nature of the offense? What County(ies) and State(s)? _____________________
_______________________________________________________________________________________________________________
When? ________________________________________________________________________________________________________
Ever used any other name(s)? Yes _____ No _____ If yes, list name(s) ___________________________________________________
Are you or any other household member a Registered or Unregistered Sex Offender? Yes _____ No _____
Are you or any other household member currently using any illegal drugs?
Yes _____ No _____
Auto/Year/Make/Lic#: 1.)____________________________________________________2.)________________________________________________
Local Contact_______________________________Address____________________________________________Tel#___________________________
Nearest Relative_____________________________Address____________________________________________Tel#___________________________
Emergency Contact__________________________ Address____________________________________________Tel#___________________________
In compliance with the Fair Credit Reporting Act, State and Federal laws, this is to inform you that an investigation involving the
statements made on this application for tenancy is being initiated by ORCA Information, Inc., 360-588-1633, PO Box 277,
Anacortes, WA 98221. I certify that to the best of my knowledge all statements are “true & complete”. I further authorize ORCA
,
Information, Inc. to obtain CREDIT REPORTS
EMPLOYMENT REFERENCES, COURT, CRIMINAL & JUVENILE
RECORDS, ARREST DETENTION INFORMATION and CHARACTER REFERENCES, GENERAL REPUTATION,
MODE OF LIVING, and RENTAL REFERENCES as needed to verify all information put forth on this application.
SCREENING FEE IS NON-REFUNDABLE
.
Applicant’s Signature______________________________________________________________
Date________________________
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