Rental Application Page 1/2
Note: Only COMPLETED applications are accepted.
Unverifiable information and insufficient rental history will NOT be accepted.
All occupants age 17 and over must submit a separate application.

Rental Application for (address)_________________________________________________________

Requested move-in date________________________ Lease term______________________________

Full Name________________________________ Former Full Name___________________________

Social Security No.___________________ Year in which SSN was applied for_________________

State in which SSN was applied for________________________Phone______________________

Drivers Lic. No.__________________________ Exp.Date_________

D.O.B.___________ Present Address___________________________________________________

P.O. Box address________________________________________________

How long at present address?______ Rent $______ Reason for moving___________________________

Manager______________________________ Phone__________________

Owner of Record (who the real estate tax bill is sent to)_________________________Phone__________

Previous Address___________________________________________________ How long?______

Rent $______ Reason for moving________________________________________________________

Manager______________________________ Phone__________________

Owner of Record____________________________________Phone_________________

Name, D.O.B., SSN, and relationship of every person who will live with you, even temporarily:________

___________________________________________________________________________________

___________________________________________________________________________________

Any pets?_______ Describe_________________________ Waterbed?_______

Occupation_____________ Employer___________________________________________________

How long?____________ Supervisor__________________Phone_________________
 
 

Rental Application Page 2/2

Current Gross Monthly Income (before deductions) $_______________ List sources of income other

than present employment_____________________________________________________

Previous Occupation_____________ Employer______________________________________

How long?____________ Supervisor_____________________Phone___________

Savings Account: Bank______________________ Phone_______________ Acct. No._____________

Checking Account:Bank_____________________ Phone________________ Acct. No._____________

Have You: Ever filed bankruptcy?_____ Ever been convicted of a felony?_____ Ever forclosed on?____

Have you ever been a defendant or occupant in a collection, garnishment or eviction filing ?_____

Explain any "yes"  answers below or on back of page..

Vehicle(s) Make(s)___________ Model(s)_______ Year(s)_______ License(s)__________________

Personal Reference________________________Address___________________ Phone___________

Contact in Emergency_____________________Address____________________ Phone___________

I declare that the statements above are true and correct. I authorize verification of all of the above
information including my references, residency, credit and criminal history as they relate to my tenancy and
to future rent collections.

Signed___________________________________________  Date:____________
 
 
 
 
 
 
 
 
 
 

Verified: SSN___DL/ID___CurTen___Prev___Empl___Inc___Prev___Credit___Refs___Cmnl____By___