Application To Rent Page 2
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1
2
3Employment or Source of Funds
Financial Information
Name of Employer/
Checking Account #
Source of Funds
Phone Number
Bank Name & City
Supervisor
Savings Account #
Position
Bank Name & City
Employed Since
Credit Cards?
Yes
No
Type of Credit
Mastercard
Visa
Gross Monthly
Card(s)?
Salary/Funds
Discover
AmEx
Have you had a
Yes
No
Other Sources of
Bankruptcy?
Funds & Amount
PERSONAL REFERENCES:
Name: _________________________________
Address: ____________________________________________
Telephone #: (______)_____________________
Relationship to Applicant: ______________________________
Name: _________________________________
Address: ____________________________________________
Telephone #: (______)_____________________
Relationship to Applicant: ______________________________
MISCELLANEOUS:
Question
Yes
No
Explanation
Where?
• Do you own any real estate?
• Do you have any pets?
• Have you ever been arrested or
charged with a crime?
• Have you ever received an
Eviction Notice from a landlord?
• Have you ever been evicted by a
landlord?
• Do you smoke?
EMERGENCY CONTACTS:
In case of emergency notify:
Name: _______________________________________ Telephone #:______________
Address: ___________________________________
Relationship: ______________
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Parent category: Business