Rental Application (One Person Per Application) Form Page 2

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RENTAL APPLICATION
(ONE PERSON PER APPLICATION)
Personal reference: (List name, address, telephone number and relationship) _____________________________________________
_____________________________________________________________________________________________________________
Emergency information: (List name, address, telephone number and relationship) _________________________________________
_____________________________________________________________________________________________________________
If you could not meet your financial obligations, who would you turn to for help? __________________________________________
Do you currently carry renter's insurance?
Yes
No
Amount: $ _________________________________________
Company name: _______________________________________________________________________________________________
Does anyone in your household smoke?
Yes
No
Have you ever been served an eviction notice or have you been asked to leave a rental property?
Yes
No
If so, when? __________________ and why? ________________________________________________________________________
List the Landlord's name, address and telephone number: _____________________________________________________________
Have you ever deposited rent with a court or refused to pay your rent when it was due?
Yes
No
If the answer is yes, please explain: ________________________________________________________________________________
Have you ever been convicted of a felony?
Yes
No
If so, list the charge, year, county and state: _________________________________________________________________________
Have you ever filed bankruptcy?
Yes
No
If so, when? _________________________________________________
Has it been discharged?
Yes
No
If yes, when? ________________________________________________________
What type of bankruptcy?
Chapter 7
Chapter 13
Have your wages ever been garnished?
Yes
No
If so, when and why _______________________________________
Are you currently a co-signer on a loan?
Yes
No
I certify that all of the information listed above is truthful and complete. I give permission for a CREDIT REPORT AND CRIMINAL
ECORD SEARCH to be run for tenant screening purposes. THE TENANT RELEASE FORM MUST ACCOMPANY THIS APPLICATION.
Signature: ________________________________________________________________ Date: ____________________________
Page 2
FORM PROVIDED BY SCREENING SERVICES INC. CALL 440.230.2929 OR 855-OK2RENT.

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