Mississippi Rental Application Template
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1MISSISSIPPI RENTAL APPLICATION
Neatly complete all information below. All applicants over the age of 18 must complete and sign their own application.
Applicants full name___________________________________Phone #___________________DOB__________
Social Security #_______________Drivers License #__________ State________ Exp.________
Current Address________________________________City___________________State________Zip_________
Current Landlords Name__________________________________Landlords Phone #______________________
How long at this address__________Reason for leaving______________________________________________
Previous Address________________________________City___________________State_______Zip_________
Previous Landlords Name__________________________________________Phone #______________________
How long at this address__________Reason for leaving______________________________________________
Auto Yr______Make____________Model_____________________State/License Plate #___________________
Present Employer_____________________________Position__________________Mo. Income_____________
Phone #__________________How long at job_________Other income/source____________________________
Employers Address_________________________________________City___________________State________
Number and type of Pets___________________________Have you ever been party to an eviction? ☐Yes ☐No
Name of bank_________________________Branch_____________________Type of
Account_______________
Name of bank_________________________Branch_____________________Type of
Account_______________
Personal References
Name______________________________Yrs. Known____ Relationship____________Phone #_____________
Name______________________________Yrs. Known____ Relationship____________Phone #_____________
Name______________________________Yrs. Known____ Relationship____________Phone #_____________
Total number of adults___________Total number of children living with you under the age of 18_____________
Names and relations of all other applicants_________________________________________________________
___________________________________________________________________________________________
I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize __________
investigation of all statements contained in this application for tenant screening as may be necessary in arriving at
a tenant decision, I understand that the landlord may terminate any rental agreement entered into for any
misrepresentations made above.
Signature________________________________________________________________Date________________
Received from applicant the non-refundable sum of $____dollars to pay for tenant screening service.
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