RENTAL APPLICATION
A separate application is required from each applicant 18 years or older.
APPLICATION FEE: $______
THIS SECTION TO BE COMPLETED BY LANDLORD
Address of property to be rented: ___________________________________________
The term of this rental is: (check one)
Fixed Lease (from: _________________, 20____ to: _________________, 20____)
Month-to-Month (starting: _________________, 20____)
Amounts Due Prior to Occupancy
First month’s rent $ __________
Security deposit $ __________
Credit check fee $ __________
Other: _______________ $ __________
TOTAL: $ __________
THIS SECTION TO BE COMPLETED BY APPLICANT
Applicant Personal Information
Full Name: __________________________________
Home phone: ____________________ Work phone: ____________________
Social Security Number (SSN): ____________________
Driver’s License Number: _________________ State of: _________________
Vehicle Information
Do you have a vehicle? Yes No
Make: _________________ Model: __________________ Color: _________________
Year: _________________
License Plate Number: _________________ License Plate State: _________________
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Occupants
List the full names of ALL Occupants: _______________________________________
Applicant’s Rental History
Do you currently rent? Yes No
If Yes, enter the Current Address: _________________________________________
Start Date: _________________, 20____ End Date: _________________, 20____
Reason for Leaving: _____________________________________________________
Landlord/Manager’s Name: ___________________________________
Phone: _________________ E-Mail: ________________________________________
Previous Address (if rental property): _______________________________________
Start Date: _________________, 20____ End Date: _________________, 20____
Reason for Leaving: _____________________________________________________
Landlord/Manager’s Name: ___________________________________
Phone: _________________ E-Mail: ________________________________________
Employment History
Current Employer: __________________________________
Address: _________________________________________
Start Date: _________________, 20____ End Date: _________________, 20____
Supervisor’s Name: __________________________________
Phone: _________________ E-Mail: ________________________________________
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Previous Employer 1: __________________________________
Address: _________________________________________
Start Date: _________________, 20____ End Date: _________________, 20____
Supervisor’s Name: __________________________________
Phone: _________________ E-Mail: ________________________________________
Previous Employer 2: __________________________________
Address: _________________________________________
Start Date: _________________, 20____ End Date: _________________, 20____
Supervisor’s Name: __________________________________
Phone: _________________ E-Mail: ________________________________________
Gross Income
Gross Monthly Employment Income (before deductions): $________________
Average Monthly Amounts of Other Income (if any): $________________
Total Income: $________________
Financial Liabilities
Do you have any loans? Yes No
If Yes, what are the amounts and reasons: ___________________________________
Do you have any credit card debt? Yes No
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If Yes, what are the amounts and the card issuers: _____________________________
Are there any other debts we should know about? Yes No
If Yes, explain: _________________________________________________________
Pets
Do you have any pets? Yes No
If Yes, enter the type and weight: ___________________________________________
Smoking
Do you currently smoke? Yes No
If Yes, what products: ____________________________________________________
Legal Action
Have you ever filed for bankruptcy? Yes No
If Yes, explain: _________________________________________________________
Have you ever been sued? Yes No
If Yes, explain: _________________________________________________________
Have you ever been evicted? Yes No
If Yes, explain: _________________________________________________________
Personal References
Personal Reference 1: __________________________________
Relationship: __________________________________
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Phone: _________________ E-Mail: ________________________________________
Personal Reference 2: __________________________________
Relationship: __________________________________
Phone: _________________ E-Mail: ________________________________________
Personal Reference 3: __________________________________
Relationship: __________________________________
Phone: _________________ E-Mail: ________________________________________
I, the applicant, certify that all the information given above is true and correct and
understand that my lease or rental agreement may be terminated if I have made any
material false or incomplete statements in this application. I authorize verification of the
information provided in this application from my credit sources, current and previous
landlords and employers and personal references.
Applicant’s Signature: ________________________________ Date: _____________
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