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Property applying for

Applicant

First Name Middle Name Last Name SSN Phone number Email Facebook Drivers License # Issuing State DOB Number of Dependants

Current home address

Address Suite/Apt City State Zip

Co-Applicant

First Name Middle Name Last Name Relationship to Applicant SSN Phone number Email Facebook Drivers License # Issuing State DOB Number of Dependants

Current home address

Address Suite/Apt City State Zip

Additional Occupants

Other Occupants and Relationship to Applicant/Co-Applicant. Include ages of minor children.

(1) Name Relationship Age
(2) Name Relationship Age
(3) Name Relationship Age
(4) Name Relationship Age
(5) Name Relationship Age

Is either co-applicant, or any anticipated occupant a member of the armed services, reserves or National Guard?

Other Prior Addresses

(Beginning with current or most recent and for the last 7 years)

Current/Most Recent Address

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Previous Address 2

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Previous Address 3

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Previous Address 4

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Applicant's Employment History

(Beginning with current or most recent and for the last 7 years)

Current Employer

Employer Name Supervisor Start Date Address City State zip Employer phone Monthly income (take home pay) Hourly rate

Previous Employer 2

Employer Name Supervisor Start Date End Date Address City State zip Employer phone Monthly income (take home pay) Hourly rate

Previous Employer 3

Employer Name Supervisor Start Date End Date Address City State zip Employer phone Monthly income (take home pay) Hourly rate

Co-Applicant Employment History

(Beginning with current or most recent and for the last 7 years)

Current Employer

Employer Name Supervisor Start Date Employer phone Monthly income (take home pay) Hourly rate

Previous Employer 2

Employer Name Supervisor Start Date End Date Employer phone Monthly income (take home pay) Hourly rate

Previous Employer 3

Employer Name Supervisor Start Date End Date Employer phone Monthly income (take home pay) Hourly rate

Other income

Additional regular and current sources of income: SSI, Disability, child support, investments, etc.

(1) Income source Amount
(2) Income source Amount
(3) Income source Amount

Banking/Credit Union Accounts/Available Credit/Other

Bank Name City and State
(1) Current Monthly Payments Monthly payment amount Balance
(2) Current Monthly Payments Monthly payment amount Balance
(3) Current Monthly Payments Monthly payment amount Balance

Vehicles in Possession of Applicant/Co-Applicant

(1) Make/Model Year License Number State
(2) Make/Model Year License Number State

Pets

[$150 pet fee (non-refundable; due at lease signing), $25 monthly per pet (non-refundable); maximum of 2 pets]

Do you have any pets?

Personal References

(1) Name Address Phone Relationship
(2) Name Address Phone Relationship

Other

Has the Applicant or Co-Applicant ever been evicted or asked to move out?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever broken a rental agreement or lease contract?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever been late with rent payments or sued for non-payment of rents?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever been sued for damages to a rental property?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever declared bankruptcy?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever had any judgments against you?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever been convicted of a misdemeanor or a felony, Ex: assault, traffic convictions, offenses related to your pet, or any offense involving the use or abuse of drugs, including alcohol?

Applicant Co-Applicant

If yes to any of the above questions, please give the details below including offense charged, offense convicted of, jurisdiction/court in which conviction occurred, date of conviction, and the circumstances upon which conviction was based.

Emergency Contacts

(1) Name Address Phone Relationship
(2) Name Address Phone Relationship

Next of Kin

Next of kin/nearest relative not living with you

Name Address Phone Relationship

I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE, CORRECT AND COMPLETE; I HEREBY AUTHORIZE LANDLORD OR HIS/HER AGENT TO MAKE, NOW AND DURING ANY TENANCY THAT MAY ENSUE, ANY INQUIRIES/CONTACTS NECESSARY TO EVALUATE/VERIFY THE INFORMATION I HAVE PROVIDED HEREIN, TO INCLUDE INQUIRING WITH THE APPROPRIATE CREDIT CHECKING AUTHORITIES AND/OR JUDICIAL JURISDICTIONS, AND CONTACTING THE REFERENCES WHICH I HAVE LISTED HEREIN. IF I RENT THE IDENTIFIED PREMISES, I UNDERSTAND THAT THE INFORMATION CONTAINED ON THIS FORM AND ON ANY RENTAL AGREEMENT MAY BE MAINTAINED BY LANDLORD FOR UP TO SIX YEARS AFTER I VACATE THE PREMISES, OR AS NEEDED BY LANDLORD TO RECOVER ANY LOSSES ARISING OUT OF SUCH TENANCY. I UNDERSTAND THAT THE LANDLORD MAY AT ANY TIME TERMINATE MY RENTAL AGREEMENT FOR ANY MISREPRESENTATIONS MADE HEREIN.

Applicant

I have read and accept the terms above.

Name Date

Co-Applicant

I have read and accept the terms above.

Name Date

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