Rental Application Form Page 2

In   C ase   o f   E mergency,   C ontact:  

 

Name:

Phone   # :

City:

State:

Relationship:

Name:

Phone   # :

City:

State:

Relationship:

Rental   A ssistance  

 

Rental   A ssistance   /   S ubsidy   T ype:

Voucher   A mount:

Expiration   D ate:

Case   N umber:

Case   W orker   N ame:

Case   W orker   P hone   N umber:

Residency   I nformation  

 

HOW   M ANY   O CCUPANTS   W ILL   B E   L IVING.  

EACH   ADDITIONAL   A DULT   L IVING     IN   T HE  

IF   T HIS   I S   N OT   F ILLED   O UT  

IN   T HIS   A PT   B ESIDES   A PPLICANT  

APT.   O VER   T HE   A GE   O F   1 8     YEARS   I S   R EQUIRED  

IT   I NDICATES   T HAT   N O   O THER   P ERSON  

SIGNED   O N   T HIS   L EASE   P LEASE   L IST   A LL:  

 

TO   F ILL   O UT   A   S EPARATE   A PPLICATION:  

 

WILL   B E   L IVING   I N   T HE   A PT.   :

Total   A dults:

Total   C hildren   U nder   1 8   Y ears   :

Pets:  

NO   P ETS   A LLOWED

FULL   N AME  

SEX  

DATE   O F   B IRTH  

RELATIONSHIP   T O   A PPLICANT

Have   y ou   e ver:  

 

Filed   f or   b ankruptcy?   I f   y es,   l ist   d ate   f iled:  

Been   s erved   a n   e viction   n otice   o r   b een   a sked   t o   v acate   a   p roperty   y ou   w ere   r enting?   I f   y es,   w hen?  

Willfully   o r   i ntentionally   r efused   t o   p ay   r ent   w hen   d ue?   If   y es,   w hen?  

 

Been   s ued   f or   u nlawful   d etainer?   I f   y es,   w hen?  

Been   c onvicted   o f   o r   c ommitted   a   f elony?   I f   y es,   w hat?  

Been   c harged   o r   a rrested   f or   d rug   p ossession   o r   s ale?  

 

 

Referred   t o   u s   b y:                         o Newspaper   ( name)                                                           o Realtor   ( name)                                                                                         o Other                                                                            

 

I  hereby  deposit  with  the  management  company  a  rent  deposit  in  the  sum  of  $                       o n  the  above  premises  pending  approval  of  this  application.  I  

understand  that  my  rent  deposit  may  be  applied  to  any  rent  loss,  re-­‐rental  fee  etc.  If  I  don’t  bring  the  rest  of  the  deposit  by:                   / _             /_                               if  

the  application   i s  approved   a nd   I ’m   u nable  to  fulfill   t he  conditions   o f   o ccupancy,  my  deposit  will   n ot  be  returned.  The  deposit  will   o nly  be  returned  

if  this  application  is  not  approved  providing  that  all  above  question  was  answered  truthfully.  All  returned  moneys  would  be  returned  with  a  check  

only.   I   hereby   consent   to   allow,   through   its   designated   agent   and   its   employees,   to   obtain   and   verify   my   consumer   information   (including   credit,  

criminal  and   public  records  information)  for  the  purpose  of   determining   whether  or  not  to  lease   to  me   an   apartment.     I  understand   that  should  I  

lease   an   apartment,   and   its   agent   shall   have   a   continuing   right   to   review   my   consumer   information,   rental   application,   payment   history   and  

occupancy   history   for   account   review   purposes   and   for   improving   application   methods.   I   declare   under   penalty   of   perjury   that   the   information  

listed   i n   t his   a pplication   i s   t rue   a nd   c orrect.  

Signature   o f   A pplicant:      

 

Date:            

 

 

 

:    

 

Remarks   o r   p ersonal   s tatement   p lease   w rite   h ere

 

 

 

 

FAILURE   T O   F ILL   O UT   T HE   A PPLICATION   C OMPLETELY   W ILL   R ESULT   I N   A   D ELAY   O F   P ROCESSING   Y OUR   A PPLICATION  

 

 

 

RENTAL   ADDRESS         -­‐       OFFICE   U SE   O NLY

Rental   P roperty   A ddress:

Apt.   # :

Bedroom:

City:

State:

Interviewed   B y:

Today’s   D ate:

Move   i n   D ate:

Rent/Month: