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Rental Application

Address of property to be rented: 674 Brownwood Ave SE, Left Unit, Atlanta, Ga 30316
APPLICANT
Full Name: ___________________________________________________________ Date of birth: _____________
Home or Cell Phone: (_____) ___________________________ Work Phone: (_____) __________________________
Social Security Number:____________________________ Email address: _____________________________________
Drivers License Number/State: __________________________ License Plate Number/State: _____________________
Vehicle Make: _________________________ Model: ____________________Color: ______________Year:_______
ADDITIONAL OCCUPANTS
List everyone, including children, who will live with you:
Full Name

Relationship to Applicant

_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
RENTAL HISTORY
Current Address: ______________________________________________________________________________________
Dates Lived at Address: ___________________________ Reasons for leaving:__________________________________
Landlord/Manager: _______________________________ Landlord/Managers Phone: (________) ________________
Landlord/Manager email address: ________________________________________________________________________
Previous Address: ______________________________________________________________________________________
Dates Lived at Address: ___________________________ Reasons for leaving:__________________________________
Landlord/Manager: _______________________________ Landlord/Managers Phone: (________) ________________
Landlord/Manager email address: ________________________________________________________________________
Previous Address: ______________________________________________________________________________________
Dates Lived at Address: ___________________________ Reasons for leaving:__________________________________
Landlord/Manager: _______________________________ Landlord/Managers Phone: (________) ________________
Landlord/Manager email address: ________________________________________________________________________
EMPLOYMENT HISTORY
Name and Address of Current Employer: ___________________________________________________________________
_____________________________________________________________ Phone: (________) _______________
Name of Supervisor: ____________________________________________ Phone: (________) _________________
Supervisors (or HR) email address: ______________________________________________________________________
Dates Employed at this Job: ____________________________ Position/title: __________________________________
Name and Address of Previous Employer: __________________________________________________________________
_____________________________________________________________ Phone: (________) _______________
Name of Supervisor: ____________________________________________ Phone: (________) _________________
Supervisors (or HR) email address: ______________________________________________________________________
Dates Employed at this Job: ____________________________ Position/title: __________________________________

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INCOME
1. Your gross monthly employment income (before deductions):

$ ________________________

2. Average monthly amounts of other income (specify sources):

$ ________________________
$ ________________________

TOTAL:

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
yes

Been convicted of a crime?

Had eviction process started against you?


Been sued?

yes

no
yes

no

no

Explain any yes listed above: ___________________________________________________________________________


_____________________________________________________________________________________________________

REFERENCES AND EMERGENCY CONTACT


Personal Reference: _______________________________________ Relationship: ____________________________
Address: ____________________________________________________________ Phone: ___________________

Personal Reference: _______________________________________ Relationship: ____________________________


Address: ____________________________________________________________ Phone: ___________________

Contact in Emergency: ____________________________________ Relationship: ____________________________


Address: ____________________________________________________________ Phone: ___________________
I authorize Valerie Raimonde to obtain information about me from my credit sources, credit bureaus, current and
previous landlords and employers, and personal references. I authorize my credit sources, credit bureaus, current
and previous landlords and employers and personal references to disclose such information about me that is
relevant to the evaluation of me as a prospective tenant.
I certify that all the information given here 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 understand that by signing this consent form I will be responsible for a credit/background check fee.
_______________________________________________________________________________ __________
Signature
Date

_______________________________________________________________________________
Print name

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