Rental Application

Equal Housing Opportunity

The undersigned hereby makes an application to rent the following property: ______________________

____________________________________________________________________________________ .

Anticipated move date of ___________________at a monthly rent of $_______________ and security

deposit of $_______________.

PLEASE TELL US ABOUT YOURSELF

Full Name _______________________________ Home Phone ( ______ ) ______________________

Date of Birth _____ / _____ / _____ Social Security #__________ - ________ - __________

Email Address: __________________________ (optional) Other Phone ( ______ ) __________________

Co-Applicant Name _________________________ Names of Dependents ______________________

Co-Applicant Date of Birth_____ / _____ / _____ Social Security #__________ - ________ - __________

Dependents Date of Birth _______________________________________________________________

List All Pets __________________________________________________________________________

PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)

Current Address _______________________________________________ Apt# __________________

City ________________________________________________________ State______ Zip__________

Month/Year Moved In___________ Reasons for Leaving_______________________ Rent $ _________

Owner/Agent ____________________________ Phone ( ______ ) _____________________________

Previous Address (last 3 years) __________________________________________ Rent $ _________

Owner/Agent ____________________________ Phone ( ______ ) _____________________________

PLEASE DESCRIBE YOUR CREDIT HISTORY - Mark with an "X"

Have you declared bankruptcy in the past seven (7) years? Yes___________ No____________
Have you ever been evicted from a rental residence? Yes___________ No____________
Have you had two or more late rental payments in the past year? Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due? Yes___________ No____________

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PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION - Mark with an "X"

Your Status: _____Full Time _____Part Time _____Student _____Unemployed

Employer ____________________________________________________________________________

Dates employed_____________________ Employed as ______________________________________

Supervisor Name_________________________ Phone ( ______ ) _____________________________

Salary $_________________per________________. (If employed by above less than 12 months, give

name & phone of previous employer or school: ______________________________________________ .)

If you have other sources of income that you would like us to consider, please list income, source, and
person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony,
child support, or spouse's annual income unless you want us to consider it in this application.

Amount $___________________ Source/Contact Name ______________________________________

PLEASE LIST YOUR REFERENCES

Banking Accounts:

Name_________________ Type of Account_________________ Account Number_________________

Name_________________ Type of Account_________________ Account Number_________________

Personal Reference or Emergency Contact:

Name _______________________ Address _______________________________________________

Phone _______________________ Relationship_______________________

Driver's License:

Your Driver's License Number_________________ State_________________

Vehicle Information:

Make / Model _________________Year _________________License Plate State_________________

ADDITIONAL INFORMATION:

Please give any additional information that might help owner/management evaluate this application?

____________________________________________________________________________________

____________________________________________________________________________________

Where may we reach you to discuss this application?

Day Phone # ( ) ________________________ Night Phone # ( ) ______________________

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I hereby apply to lease the above described premises for the term and upon the set conditions above set
forth and agree that the rental is to be payable the first day of each month in advance. As an inducement
to the owner of the property and to the agent to accept this application. I warrant that all statements
above set forth are true; however, should any statement made above be a misrepresentation or not a true
statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in
processing my application.

I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted
in 3 business banking days. Upon acceptance, this deposit shall be retained as part of the security
deposit. When so approved and accepted, I agree to execute a lease for ___________ months before
possession is given and to pay the balance of the security deposit prior to the move in date. If the
application is not approved or accepted by the owner or agent, the deposit will be refunded, the
application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent
may reject. I recognize that as a part of your procedure for processing my application, an investigative
consumer report may be prepared whereby information is obtained through personal interviews with
others with whom I may be acquainted. This inquiry includes information as to my character, general
reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.

Please sign: X ______________________________________ _____________________________

Applicant's Signature Date

AUTHORIZATION
Release of Information

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of
renting a house, apartment, or condominium from this owner/manager.

_____________________________________________
Name (please print)

X _______________________________________ __________________________
Signature Date

APPLICANT: PLEASE DO NOT WRITE in BOX (FOR OFFICE USE ONLY)

Deposit of $_________________ Received by _________________________Date___________

OFFICE NOTES:

Please note that this document is for reference purposes. You may wish to check with your local landlord
association or obtain legal advice to make sure information is appropriate for your state. This Application was
modified and made fillable by eForms.

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