Residential Lease Application

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Received on _____________________(date)
at _____________________(time)
by __________________ (initials)
Residential Lease Application
Each occupant and co-applicant 18 years or older must submit a separate application
Property Address: _________________________________________________________
Anticipated Move in Date:___________________ Monthly Rent:___________
Security Deposit:_________________
Applicant was referred to Landlord by:
□ Real Estate Agent _______________________________________________
□ Newspaper □ Sign
□ Internet □ other__________________________
Applicant’s name (First, Middle, Last) ________________________________________
Is there a co-applicant? □ yes □ no
(if yes, co-applicant must submit a separate application)
Applicants former last name (maiden or married) ________________________________
E-mail: ________________________________ Home Phone______________________
Work Phone: ___________________________ Cell Phone:________________________
Emergency Contact Name & No. ____________________________________________
Marital Status ____________________ Citizenship __________________ (country)
Social Security No. _____________________________
Drivers License No ______________________ In _________________ (state)
Date of Birth ______________________ Height _________ Weight________
Eye Color ____________ Hair Color ____________
Name all other persons who will occupy the Property:
Name: ______________________________ Relationship: ______________ Age______
Name: ______________________________ Relationship: ______________ Age______
Name: ______________________________ Relationship: ______________ Age______
Name: ______________________________ Relationship: ______________ Age______
Applicants current address: _____________________________ apt # _____________
_____________________________________(city, state, zip)
Landlords name: _________________________________________________________
Landlords phones: _________________ (day) _____________________________(night)
_________________(cell) ____________________________(email)
Date moved-in _________________ Move out date _________________ Rent $______
Reason for move_________________________________________________________
Applicants previous address: ____________________________ apt # _____________
_____________________________________(city, state, zip)
Landlords name: _________________________________________________________
Landlords phones: _________________ (day) _____________________________(night)
_________________(cell) ____________________________(email)
Date moved-in _________________ Move out date _________________ Rent $______
Reason for move_________________________________________________________
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