Rental Application

Separate application required from each applicant age 18 or older.

Address of Property to be Rented:

Applicant: Full Name include all names you use(d).
First Name: _______________________ Middle Initial: ______ Last Name: _______________________________
Home Phone: ______________________ Cell Phone: ______________________ Date of Birth: ________________
Social Security Number: _____________________ Drivers License Number/State: ___________________________
Vehicle Make: _____________________ Model: _____________________ Color: ____________ Year: __________
License Plate Number/State: ______________________________ Email: ___________________________________
Additional Occupants: List everyone, including children, who will live with you.
Full Name

Relationship to Applicant

Age

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______________________________

______

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______________________________

______

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______________________________

______

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______________________________

______

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Rental History: First-time renters: attach a description of your housing situation for the past five years.
Current Address: _______________________________________________ No. of Years at Address: ____________
Landlord/Manager: _______________________________ Landlord/Manager's Phone: ________________________
Reason for Leaving: ______________________________ Rent: $____________ Security Deposit: $_____________
Previous Address: ______________________________________________ No. of Years at Address: ____________
Landlord/Manager: _______________________________ Landlord/Manager's Phone: ________________________
Reason for Leaving: ______________________________ Rent: $____________ Security Deposit: $_____________
Employment History: Self-employed applicants: attach tax returns for the past two years.
Name and Address of Current Employer: _____________________________________________________________
Phone: _________________ Name of Supervisor: _____________________ Supervisor's Phone: ________________
Dates Employed at This Job: ___________________________ Position or Title: _____________________________
Name and Address of Previous Employer: ____________________________________________________________
Phone: _________________ Name of Supervisor: _____________________ Supervisor's Phone: ________________
Dates Employed at This Job: ___________________________ Position or Title: _____________________________
Sources of Income:
Gross Monthly Wages (base pay): $_________________ Govt Assistance (Metro): $_________________
Child Support: $______________ Spousal Support: $_______________ Other (specify): $_____________

Rental Application

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Loans/Liabilities:
Type of Loan: (mortgage, car, student loan, etc.)
Type: _______________________________ Balance Owed: $_____________ Monthly Payment: $______________
Type: _______________________________ Balance Owed: $_____________ Monthly Payment: $______________
Child Support Payments: $______________ Spousal Support: $____________ Other (specify): $________________
Bank References:
Name: _______________________ Branch: _______________________ Account No.: _______________________
Name: _______________________ Branch: _______________________ Account No.: _______________________
Credit References:
Credit Card Name: ________________________ Balance Owed: $___________ Monthly Payment: $____________
Credit Card Name: ________________________ Balance Owed: $___________ Monthly Payment: $____________
Miscellaneous:
Describe the number and type of pets you want to have in the rental property: ________________________________
Describe water-filled furniture you want to have in the rental property: _____________________________________
Do you smoke? [ ] yes [ ] no

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

How many times _____

Been sued? [ ] yes [ ] no How many times _____ Sued someone else? [ ] yes [ ] no How many times _____
Been evicted? [ ] yes [ ] no How many times _____ Refused to pay rent? [ ] yes [ ] no How many times ____
Been convicted of a felony? [ ] yes [ ] no How many times _____
Please explain any yes listed above: _______________________________________________________________
______________________________________________________________________________________________
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References and Emergency Contact:
Personal Reference: ___________________________ Relationship: ________________ Phone: _________________
Personal Reference: ___________________________ Relationship: ________________ Phone: _________________
Emergency Contact: ___________________________ Relationship: ________________ Phone: ________________
Source: Where did you learn of this vacancy? ____________________________________________________________
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. I give permission for the landlord or its agent to obtain a consumer report about me for the purpose of
this application, to ensure that I continue to meet the terms of the tenancy, for the collection and recovery of any financial
obligations relating to my tenancy, or for any other permissible purpose.
Applicant Signature: ________________________________________________ Date: ___________________________
Notes (Landlord/Manager): ___________________________________________________________________________
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Rental Application

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