RENTAL APPLICATION management@chidomicile.net | P 773.256.8704 | F 773.289.

0510

PERSONAL INFORMATION Unit: Rent: Move In:

FIRST NAME MIDDLE LAST SS#
- -
DATE OF BIRTH MARITAL STATUS DRIVER’S LICENSE # STATE
/ / SINGLE ( ) MARRIED ( ) ENGAGED ( ) DIVORCED ( ) DOMESTIC PARTNER ( )
PRIMARY PHONE SECONDARY PHONE EMAIL
- - - -

PRESENT HOME ADDRESS CITY / STATE / ZIP

LENGTH OF TIME PRESENT LANDLORD LANDLORD PHONE

- -
REASON FOR LEAVING RENT AMOUNT EVER MORE THAN (5) DAYS LATE?
( )Y ( )N
PREVIOUS ADDRESS CITY / STATE / ZIP

LENGTH OF TIME PREVOUS LANDLORD LANDLORD PHONE

- -
REASON FOR LEAVING RENT AMOUNT EVER MORE THAN (5) DAYS
LATE?
( )Y ( )N

OCCUPANTS
NAME RELATIONSHIP OCCUPATION AGE

NAME RELATIONSHIP OCCUPATION AGE

NAME RELATIONSHIP OCCUPATION AGE

PETS
NAME TYPE/BREED NEUTERED/SPAYED? AGE

NAME TYPE/BREED NEUTERED/SPAYED? AGE

EMPLOYMENT / INCOME SOURCE

CURRENT EMPLOYER / SOURCE OF INCOME (PRIMARY) OCCUPATION HRS / WK

SUPERVISOR PHONE EMAIL YEARS EMPLOYED

EXT.
ADDRESS CITY / STATE / ZIP MONTHLY SALARY/INCOME

CURRENT EMPLOYER / SOURCE OF INCOME (SECONDARY) OCCUPATION HRS / WK

SUPERVISOR PHONE EMAIL YEARS EMPLOYED

EXT.
ADDRESS CITY / STATE / ZIP MONTLY SALARY/INCOME

HAVE YOU EVER BEEN EVICTED? ________ HAVE YOU EVER BEEN CONVICTED OF A FELONY? ________ HAVE YOU BROKEN A LEASE? ________ HAVE YOU EVER FILED BANKRUPTCY? __________

To secure this apartment I understand I am responsible to submit, with this application, funds in an amount equal to one month’s rent and $40 credit
check/application fee in the form of check, cash, money order, cashiers check or PayPal payment, made payable to ChiDomicile.

With this payment in the amount of one month’s rent I indicate my desire to lease the above stated apartment. I understand and agree that these funds will be
immediately deposited on the next business day and applied as first month’s rent of the lease. Upon signing this application I understand I have 48 hrs to submit all
documentation/monies mentioned herein and am liable for said funds, in full, upon execution of this agreement. I further understand that these funds are forfeited if
I am approved/offered the apartment and decide not to lease the apartment. I understand my payment in the amount of one month’s rent is refunded to me ONLY
if my application is declined. __________ APPLICANT’S INITIAL INDIATES COMPLETE UNDERSTANDING OF THIS PARAGRAPH.

I certify that I have reviewed the above application and that all the information contained therein is true, accurate and to my full understanding. I understand that
this application shall be incorporated in and become part of the Lease of the Premises sought and if incorrect or untrue shall result in automatic default on the part
of the applicant. If this application is accepted, I agree to rent the above premises under the terms and conditions set forth in the standard Chicago lease and fully
intend to sign the formal lease immediately prior to or upon approval. Once approved, I have 48 hrs to execute all documents necessary to complete the rental
transaction or will be considered in default of this agreement. This application and funds submitted are in good faith of my intent to finalize any and all
details/payments/deposits and complete the rental transaction. If I fail to do so, THE DEPOSIT WILL BE RETAINED AS LIQUIDATED DAMAGES and I will be
responsible for the lease in full until the apartment is re-rented. If this application is not accepted, the deposit will be refunded.
I authorize ChiDomicile to run a credit report and confirm rental, employment and income verifications and any other background information necessary to validate
my application information for a non-refundable fee of $40 plus the deposits held pending approval of this application.

APPLICANT’S SIGNATURE ___________________________________________ PRINT NAME ____________________________ DATE_________________

 PARTNERING PEOPLE • EASING TRANSITIONS

4841 N. Sawyer Ave, Unit #2 | Chicago, IL 60625

Phone: 773.256.8704 | Fax: 773.289.0510 | Email: management@chidomicile.net
____________________________________________________________________________________
TO BE COMPLETED BY THE APPLICANT:
I hereby authorize the release of rental information requested below for the purpose of processing my lease application.
Applicant SSN: ___________ - ___________ - ____________

______________________________ _____________________________________ ________________

Print Name Applicant Signature Date

TO BE COMPLETED HUMAN RESOURCES/EMPLOYER:

Name of Supervisor/H.R. Rep ________________________________
Address ________________________________
________________________________
Phone/Fax Number ________________________________

To Whom It May Concern:

This is to certify that ______________________________________________________ (Name of employee) is

working as _____________________________(Position) since_______________________(Approx. start date)

He/She is holding a permanent position and his/her annual salary is ____________________ / year.

I certify that the above information is true and correct to the best of my knowledge.

__________________________________ __________________________________
Print Name Signature
__________________________________ ___________________
Professional Title Date

We appreciate your prompt attention to this request in order to assist in expediting the approval
of this applicant. PLEASE FAX TO: CHIDOMICILE - 773.289.0510
 PARTNERING PEOPLE • EASING TRANSITIONS

4841 N. Sawyer Ave, Unit #2 | Chicago, IL 60625

Phone: 773.256.8704 | Fax: 773.289.0510 | Email: management@chidomicile.net
____________________________________________________________________________________
TO BE COMPLETED BY THE APPLICANT:
I hereby authorize the release of rental information requested below for the purpose of processing my lease application.

______________________________ _____________________________________ ________________

Print Name Applicant Signature Date

TO BE COMPLETED BY CURRENT LANDLORD / PROPERTY MANAGER:

Name of Property Manager ________________________________
Address ________________________________
________________________________
Phone/Fax Number ________________________________

To Whom It May Concern:

This is to certify that ______________________________________________________ Name of Tenant(s) lived
at ____________________________________________________________________________ Address from
_________________________ (Lease Start) to ________________________ (Lease End)
Did tenant(s) pay their monthly rent on time? _____________________________________________________
Would you rent to tenant(s)again? ______________________________________________________________
Comments:
__________________________________________________________________________________________
________________________________________________________________________________

I certify that the above information is true and correct to the best of my knowledge.

__________________________________ ___________________________________
Print Name Signature
__________________________________ ___________________
Title / Company Date

We appreciate your prompt attention to this request in order to assist in expediting the approval
of this applicant. PLEASE FAX TO: CHIDOMICILE - 773.289.0510