Fillable Vermont Rental Application (Page 2 of 3) in pdf

FINANCIAL INFORMATION (Please list all sources)

OTHER SOURCES OF INCOME

GROSS MONTHLY AMOUNT

EMERGENCY CONTACTS

Name:

Phone:

________ Relationship:

Name:

Phone:

________ Relationship:

PLEASE DESCRIBE YOUR CREDIT HISTORY (please circle)

Have you declared bankruptcy in the past seven (7) years?

Yes

Have you ever been evicted from a rental residence?

Yes

Have you had two or more late rental payments in the past year?

Yes

Have you ever willfully or intentionally refused to pay rent when due?

Yes

Have you ever been convicted of a crime or are there any pending criminal charges?

Yes

Are you subject to a lifetime state sex offender registry program in any state?

Yes

If yes, please provide type of offense, date, county, and state:

Please provide any additional information that might help owner/management evaluate this application.

the landlord is an equal opportunity housing provider. We do not discriminate on account of race, sex, sexual orientation, color, age, familial status,

marital status, religion, national origin, U.S. military veteran status, disability, gender identity, gender-related characteristics, or because the

applicant is a recipient of public assistance, including section 8 housing assistance.

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rent is to be

paid before the first day of each month. I warrant that all statements above set forth, to the best of my knowledge, are true and correct.

AUTHORIZATION TO RELEASE

I understand investigative consumer reports may be obtained in connection with my application. I understand these reports will contain

information about my background, to include but not limited to criminal history, credit history, driving record, education and prior employment

verification. The information may be obtained from Federal, State and Local government agencies. I authorize any party or its contractors to

furnish relevant information regarding myself maintained in their records. I further authorize ongoing procurement of information when

requested. I allow the landlord and it’s parties to check my references and to review my credit with ............................................................... to

evaluate my qualifications as a potential tenant; to evaluate my qualifications if the lease if the lease is to be renewed; and for rent collection

purposes. I warrant that the information supplied is true and correct. I understand that providing false or misleading information will result in the

denial of this application for rental housing.

Signature

Date

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