Fillable Iowa Lease Application Template (Page 2 of 3) in pdf

PROCESSING FEE: Applicant has paid the sum of $ ________ as a non-refundable fee for owner’s cost of processing application.

CORRECT INFORMATION: Applicant represents that all of the above statements are true and complete, and hereby authorizes verification of

above information, references, and credit records. Applicant acknowledges that false information herein will constitute grounds for rejection of this

application and may be a criminal offense. Applicant agrees to the terms of the “Application Deposit Agreement” below.

APPLICATION DEPOSIT AGREEMENT

Applicant has deposited an “Application Deposit” (in the amount stated below) in consideration of the owner/agent ’s evaluation of this application.

Applicant agrees to enter into a rental agreement within forty-eight (48) hours of verbal or written notification of application approval. Should

applicant give notice of cancellation before move -in date, or fail to take possession, owner/agent will have the immediate right to take possession and

re-let said dwelling unit. Charges for advertising, verification of information, application approval, any and all other out-of-pocket rental expenses,

and daily rent loss until dwelling unit is re-let will be deducted from security deposit. If said charges exceed security deposit amount, applicant shall

be liable for the deficiency. Owner/agent shall use due diligence in mitigating applicant ’s damages. Applicant agrees that only in the event this

application is rejected by owner/agent, shall applicant be entitled to a refund of security deposit less a twenty -five dollar ($25.00) fee for the owner’s

cost of processing the application.

DATED THIS _____________________ DAY OF ___________________________, __________, AT POLK COUNTY, IOWA.

APPLICANT’S SIGNATURE _________________________________ SPOUSE’S SIGNATURE _____________________________________

PHONE NUMBER __________________________________________ PHONE NUMBER __________________________________________

HOW WERE YOU REFERRED TO THIS COMMUNITY? (Please circle one): NEWSPAPER AD

REFERRAL

FORMER RESIDENT (Name) ______________________________ CURRENT RESIDENT (Name) _________________________________

DROVE BY AND CAME IN _______________________________ OTHER ____________________________________________________

APPLICANTS - DO NOT WRITE BELOW THIS LINE:

==============================================================================

LANDLORD:

Rated _____________By _____________ Date _____________

Rated ____________By __________ Date ___________

Accepted ____________________

CREDIT:

Rated _____________By_____________ Date _____________

Rated ____________By __________ Date ___________

Rated _____________By _____________Date _____________

Rated ____________By__________ Date ___________

CREDIT

BUREAU

Rated _____________By _____________Date______________

Rated ____________By__________ Date ___________

EMPLOYMENT:

Outlook for work – Applicant ____________________

Spouse _______________________

CLAUSES:

Co-Signer _______________

Pet Addendum ___________________

Other __________________________

APPLICATION DEPOSIT:

$ ____________________ RECEIPT NO. _________________ DATE PAID_____________ ____

RENT PER MONTH _____________________

BALANCE OF DAMAGE DEPOSIT:

$ _______________________ LEASE TERM __________________________________________

PET DEPOSIT:

$ _______________________ TYPE OF APARTMENT _________________________________

PRO-RATED AMOUNT OF RENT:

$ _______________________ MOVE-IN DATE ________________________________________

FULL ____________ MONTH RENT:

$ _______________________

TOTAL OWED PRIOR TO OCCUPANCY:

$ _______________________ RECEIPT NO. ________________ DATE PAID ______________

Iowa Lease Application Template Page 2

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