Rental Application Form Page 2
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1
2RENTAL APPLICATION FOR____________________________________
(Property Name)
INDIVIDUAL APPLICATIONS MUST BE COMPLETED FOR EACH OCCUPANT OVER THE AGE OF 18.
MISLEADING OR FALSIFICATION OF INFORMATION IS GROUNDS FOR DENIAL
OCCUPANT INFORMATION
Applicant Full Name
Date of Birth
Social Security Number
Phone Number
List all names and ages of occupants who will be living with you:
Email Address
Work Phone Number
Do any members of your household own a pet?
Yes
No
CURRENT / MOST RECENT PERMANENT ADDRESS
Address/Apt. #
State
Zip
Monthly Rent/Mortgage
City
Dates of Occupancy
Own
Rent
Landlord Phone
Landlord Name
PREVIOUS PERMANENT ADDRESS
Address/Apt. #
Monthly Rent/Mortgage
State
Zip
City
Dates of Occupancy
Own
Rent
Landlord Name
Landlord Phone
INCOME
How long?
Applicant’s Employer
Supervisor
Position Held
Employer Address
Gross Monthly or Hourly Income/Hours Per Week
Employer Phone
$
OTHER SOURCES OF INCOME (Include all sources of income you want considered in this application)
Source(s)
Gross Monthly Income
GUARDIANSHIP/ POWER OF ATTORNEY
Do you have a Guardian, Power of Attorney (POA), or designated agent (Accountant, Bank, or Financial Planner) who will be responsible
for providing rent on your behalf?
Yes
No
EMERGENCY CONTACT
Name
Email address
Phone
Address
Relationship
LEGAL PROCEEDINGS
Have you ever been evicted or have eviction proceedings ever been instituted against you?
Yes
No
Have you ever been convicted of any felony, misdemeanor, or ordinance violations, other than non-alcohol related traffic violations?
Yes
No
If yes to the above questions, give details and dates:
APPLICATION AUTHORIZATION
I have paid the earnest money deposit which will be utilized as my security deposit if the Landlord enters into a Rental Agreement with me. If this
application is approved and I fail to enter into a Rental Agreement, the earnest money and any subsequent payments may be retained to compensate
the Landlord’s cost and damages, subject to the Landlord’s duty to mitigate. If this application is rejected, withdrawn or if no action is taken by the
end of three business days after the date documented by applicant’s signature below, the earnest money and any subsequent payments will be refunded
by the end of the next business day.
I hereby authorize the Landlord to investigate my credit and financial responsibility, income, rental and eviction history and criminal background, and
any of the statements made in this application, through any means available, either public or private. I authorize the Landlord to obtain a consumer
credit report on me from a consumer reporting agency that compiles and maintains files on consumers on a nationwide basis and use any information
contained in said report. My performance under any Rental Agreement that I may enter into with the Landlord may be reported to such reporting
agency. I further authorize the Landlord to obtain a criminal background report on me through the Wisconsin Circuit Court website (or any other
means that should become available to the Landlord) and the sex offender registry.
I warrant and represent that I am at least 18 years of age and that all information and answers to the above questions are true and complete to the best
of my knowledge. I understand that providing false or misleading information or statements, exchanged now or later, may be grounds for denial of my
application. I also understand that such action may result in criminal penalties. I understand that my occupancy is contingent upon
meeting management’s resident selection criteria and providing a certificate of renters insurance at lease signing.
As required by state law, you are hereby notified that you may obtain information about the sex offender registry and persons registered with the
registry by contacting the Wisconsin Department of Corrections on the Internet at or by phone at 877-234-0085.
Date ______________________ Applicant_________________________________________________________________________________
*****FOR OFFICE USE ONLY*****
APARTMENT NO. _________________________ TYPE ____________ MOVE IN DATE
LEASE TERM
APARTMENT RENT $_____________________ OTHER _______________________ $
TOTAL RENT $
PROMOTION(S) ______________________________________________ EARNEST DEPOSIT PAID $
DATE PAID
IDENTIFICATION
IDENTIFICATION TYPE _____________________________________ IDENTIFICATION NO.
ISSUING AGENCY __________________________________________ EXPIRATION DATE
EMPLOYEE SIGNATURE ___________________________________________________________ DATE
RENTAL APPLICATION 01/16
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