This Section to Be Completed by Landlord

Rental Application

Separate application required from each applicant age 18 or older.

THIS SECTION TO BE COMPLETED BY LANDLORD

Address of property to be rented:

______

______

Rental Term: [ ] month-to-month or [ ] lease (from ______to ______)

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 - include all names you use(d): ______

Home phone: ______Work phone: ______

Social Security number: ______Drivers license number/state: ______

Vehicle make: ______Model: ______Color: ______Year: ______

License plate number/state: ______

Additional Occupants

List full names of everyone, including children, who will live with you at least 50% of the time:

______

______

______

______

______

Rental History

Current address (if rental property):

______

______

Dates lived at this address: ______Reason for leaving: ______

Landlord/manager: ______Landlord/manager’s phone: ______

Previous address (if rental property):

______

______

Dates lived at this address: ______Reason for leaving: ______

Landlord/manager: ______Landlord/manager’s phone: ______

Previous address (if rental property):

______

______

Dates lived at this address: ______Reason for leaving: ______

Landlord/manager: ______Landlord/manager’s phone: ______

Employment History

Name of current employer: ______

Address:

______

______

Phone: ______

Name of supervisor: ______Supervisor’s phone: ______

Dates employed at this job: ______to ______Position or title: ______

Name of previous employer: ______

Address:

______

______

Phone: ______

Name of supervisor: ______Supervisor’s phone: ______

Dates employed at this job: ______to ______Position or title: ______

Income

Gross monthly employment income (before deductions):$ ______

Average monthly amounts of other income (specify sources): $ ______

Sources: ______

Total Income:$ ______

Credit and Financial Information

Bank/Financial Accounts:

Account Number Bank/Institution Branch

Savings account:______

Checking account:______

Certificate of deposit account:______

Money market or similar account:______

Mutual fund or brokerage account:______

Credit Accounts & Loans (Auto loan, Visa, etc.):

Account Name of AmountMonthly
Number Creditor Owed Payment

Credit card:______

Credit card: ______

Loan (specify type):______

Other major obligations:______

Miscellaneous

Describe the number and type of pets (if any) you want to have in the rental property:

______

______

Describe the water-filled furniture (if any) you want to have in the rental property:

______

Do you smoke?[]yes[]no

Have you ever:Filed for bankruptcy?[]yes[]noBeen sued?[]yes[]no

Been evicted?[]yes[]noBeen convicted of a crime?[]yes[]no

Explain any “yes” answers from above:

______

References and Emergency Contact

Personal reference 1: ______Relationship: ______

Address: ______Phone: ______

Personal reference 2: ______Relationship: ______

Address: ______Phone: ______

Emergency contact: ______Relationship: ______

Address: ______Phone: ______

I 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.

Signature of applicant: ______Date: ______

Notes (Landlord/Manager):______

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