Rental Applicant Reference Form printable pdf download

Rental Applicant Reference Form

This form is used to obtain information regarding the rental history of Applicants for rental housing. The

information provided by the current or former Owner/Agent may be used solely for the purpose of evaluating the

applicant for rental housing. The Owner/Agent requesting this information must receive authorization from the

applicant before obtaining the information. Such authorization is granted if Applicant’s signature is provided.

Copies of this form and of the Applicant’s signature are acceptable. The Applicant may be contacted to verify the

authenticity of this request.

Please fax this form back to the person listed as soon as possible.

TO BE COMPLETED BY APPLICANT

1. Authorization by rental Applicant for the release of information

I hereby authorize the release of information requested on this form to the Owner/Agent listed. I hereby

acknowledge that the Owner/Agent can make copies of this page in order to obtain the information requested.

Name ________________________________________________ Phone number (_____) __________________

Signature _____________________________________________ Date _________________________________

TO BE COMPLETED BY OWNER/AGENT

2. Person requesting the rental reference

Name of Owner/Agent ________________________________________________________________________

Address ____________________________________________________________________________________

City __________________________________________________ State __________ Zip ___________________

Phone number (_____) _______________________ Fax number (_____) ________________________________

TO BE COMPLETED BY FORMER OR CURRENT OWNER/AGENT

3. Rental reference information

Which property address did the applicant rent from you? ______________________________________________

What were the dates of occupancy? From (month/year) ________/________ To (month/year) ________/________

How much was the rent? ________ How many times did the Applicant pay the rent late? 0 1-2 3-5 6 or more

Was any check from Applicant returned due to non-sufficient funds (NSF)? ________________________________

Did you ever serve a Three Day Notice to Applicant? ___________________________________________________

If yes, please explain ____________________________________________________________________________

Did you ever file an unlawful detainer against Applicant for unpaid rent? __________________________________

If yes, what was the result? _______________________________________________________________________

Did you ever serve the Applicant with any other notice? ________________________________________________

If yes, what kind? _______________________________________________________________________________

Did the applicant leave owning any money? If so, how much? For what? __________________________________

Does the applicant owe any amount for delinquent rent, utilities, or damage to the unit? _____________________

Did you withhold any of the Applicant’s deposit? _____________________________________________________

If yes, why? ___________________________________________________________________________________

Did the Applicant leave the premises clean and undamaged? ____________________________________________

Did the Applicant provide notice for ending tenancy according to the terms of the rental agreement? ___________

If you had the opportunity, would you rent to this Applicant again? _______________________________________

Information provided by: Name _______________________________________ Date _______________________

Phone number (_____)________________

Rental Applicant Reference Form