Nebraska Rental Application
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1
2NEBRASKA RENTAL APPLICATION
Notice: Co-Signer must complete a separate Co-Signer Application Form
Application Fee $
/each • Security Deposit $
• Monthly Rent $
The undersigned hereby makes application to rent at:
beginning on
/
/
at a monthly rental rate of $
Agent:
PLEASE TELL US ABOUT YOURSELF
FULL NAME
Hm Ph:
Date of Birth
/
/
Social Security No.
-
-
Cell Ph:
Driver's Lic. No. & State
E-mail Address
Other Occupants:
Name
Name
Name
Age 19 or over?
Age 19 or over?
Age 19 or over?
Relationship
Relationship
Relationship
Any Pets?
If so, what type and how many?
PLEASE GIVE YOUR RESIDENCE HISTORY FOR THE PAST 3 YEARS (Beginning With Most Current)
Current Address
City
State
Zip
Month & Year Moved In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
Previous Address
City
State
Zip
(If within 3 years)
Month & Year Moved In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
Previous Address
City
State
Zip
(If within 3 years)
Month & Year Moved In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
PLEASE GIVE YOUR EMPLOYMENT INFORMATION
YOUR STATUS:
Self Employed
Employed Full-Time
Employed Part-Time
Student
Retired
Not Employed
***If you are self employed , you must provide a copy of your most recent tax return for proof of income.
CURRENT EMPLOYER (or Most Recent)
Address
Phone (
)
Date(s) Employed / From
to
Fax (
)
Supervisor
Gross Monthly Salary
Position
PREVIOUS EMPLOYER
Address
Phone (
)
Date(s) Employed / From
to
Position
If there are other sources of income you would like us to consider, please list income, source and person (Banker, Employer, etc.) who we could call
for confirmation. You do NOT have to reveal alimony, child support or spouse's annual income unless you want us to consider it in this application.
Amount $
Per
Source
Telephone
HAVE YOU EVER:
Been sued for non-payment of rent?
Yes
No
Been evicted or asked to move out?
Yes
No
Broken a rental agreement or lease?
Yes
No
Been sued for damage to rental property?
Yes
No
Declared bankruptcy?
Yes
No
Been convicted of a felony?
Yes
No
If so please explain
CONTINUED OVER
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Parent category: Business