Rental Application Form Page 2
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1
2Previous Landlord or mortgage company
Previous Landlord or mortgage company
Telephone number (home)
(work)
Monthly rent or mortgage payment
Date of move-in
Date of move-out
Personal References
Name
phone
Address
Name
phone
Address
Emergency
In case of emergency contact
Relationship
phone
Occupants
List all occupants
Pets
List any pets: type
breed
weight
age
List any pets: type
breed
weight
age
Vehicles
List vehicles to be parked at premises:
make
model
year
make
model
year
Credit/Criminal History
Bank name
phone
Address
Checking account number
List all credit obligations with minimum monthly payment:
Have any of the occupants listed above ever been: convicted of a felony?
received deferred adjudication for a
felony?
been evicted?
broken a lease?
declared bankruptcy?
The above listed applicant declares that all statements made in this application are true and complete. Applicant hereby
authorizes the National Association of Independent Landlords to verify all of the information in this application and obtain
credit reports on the above listed applicant and/or applicant’s. If applicant or applicant’s spouse has given any false
information Landlord is entitled to reject the application, and retain all application fees as liquidated damages for Landlord’s
time and expenses in processing this application. Applicant shall give Landlord a nonrefundable application fee in the amount
of $
.
Signature of applicant
Date
Signature of Spouse
Date
Signature of Landlord or Landlord’s agent
Date
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Parent category: Business