Applicant Information
Today’s Date: Name: Email:Date of birth: / SSN: / Home Phone:
Current address: / Cell Phone:
City: / State: / ZIP Code:
Do you smoke cigarettes? Yes No
Landlord ‘s Name: Landlord’s Home Phone: Landlord’s Cell Phone:
Own Rent / Monthly payment or rent: / How long?
# of people to live with you: / # of Adults: / # of Children:
Reason for moving:
Previous address:
City: / State: / ZIP Code:
Own Rent / Monthly payment or rent: / How long?
Reason for Moving
Landlord ‘s Name: Landlord’s Home Phone: Landlord’s Cell Phone:
Reason for moving:
Employment Information
Current employer:Employer address: / How long?
City: / State: / Zip:
Phone: / E-mail: / Fax:
Position: / Hourly Salary / Annual income:
Previous employer:
Employer address: / How long?
Phone: / E-mail: / Fax:
City: / State: / ZIP Code:
Position: / Hourly Salary / Annual income:
Emergency Contact
Name of a person not residing with you: / Home Phone:Address: / Cell Phone:
City: / State: / ZIP Code:
Relationship:
Co-applicant Information and/or Spouse Information
Name: Email:Date of birth: / SSN: / Home Phone:
Current address: / Cell Phone:
City: / State: / ZIP Code:
Do you smoke cigarettes? Yes No
Own Rent / Monthly payment or rent: / How long?
Reason for moving
Landlord ‘s Name: Landlord’s Home Phone: Landlord’s Cell Phone:
Previous address:
City: / State: / ZIP Code:
Owned Rented / Monthly payment or rent: / How long?
Reason for moving
Landlord ‘s Name: Landlord’s Home Phone: Landlord’s Cell Phone:
Co-applicant Employment Information
Current employer: / How long?Employer address: City: State: Zip:
Phone: / Email: / Fax:
Position: / Hourly Salary / Annual income:
Previous employer: / How long?
Employer address: City: State: Zip:
Phone: / E-mail: / Fax:
Position: / Hourly Salary / Annual income:
Bank Information
Bank Name Branch Phone
Address
Checking Account No. Savings Account #
Credit References
Name
/Name
Address
/Address
Phone
/Phone
Personal References
Name
/Name
Address
/Address
Phone
/Phone
Relationship
/Relationship
Other Information# of vehicles
Make/model Year Color License plate #
Year
Make/model Year Color License plate #
Have you ever: Filed for bankruptcy? No Yes If yes, when?
Been served an eviction notice or been asked to vacate a property you were renting? No Yes If yes, when/why?
Willfully or intentionally refused to pay rent when due? No Yes If yes, when/why?
Rental Unit applied for: Commencement date / / Term Rent/Month
Landlord does not discriminate against any applicant on the basis of an illegal purpose including race, color, religion, sex, national origin, age disability, or family status. Such discrimination as the sole basis of refusal to rent is illegal throughout the United States. Local or State Laws may provide additional protected classes from discrimination. You can call the U.S. Department of Housing and Urban Development at 1-800-424-8590 to ask questions about discrimination,
I represent that the information provided in this Application is true and correct to the best of my knowledge.
I understand that this Application is not a rental agreement and that this Application does not create any obligation on the Landlord.
I understand that the information provided might be used by Landlord to determine whether to accept this Application. I authorize Landlord to verify all the information given in this application. Including banking and personal references and employment information provided.
I also authorize Landlord to perform a credit check and a criminal history check. I consent to the release of information relating to my credit and the information provided in this application.
______
Applicant’s Signature Date Spouse/Co-Applicant’s Signature Date