RENTAL APPLICATION
Application is not complete until page 5 is signed. Unless this
application is initialed on each page it will not be processed. (If more
than two persons are applying, use additional applications.)
PROPERTY ADDRESS _________________________________________________
CITY, STATE, ZIP______________________________________________________
MOVE-IN DATE _______________________________________________________
REQUIRED TO SUBMIT:
(Certified Funds or Credit Cards)
Non-Refundable Fee $_________
Holding Fee $_________
Amt. Received $_________
RENT/DEPOSITS AND OTHER FEES
(NON-REFUNDABLE) APPLICATION FEE $ ____________ (NON-REFUNDABLE) PROCESSING FEE $ ____________
RENT $ _____________ SECURITY DEPOSIT $ __________ OTHER DEPOSITS $ ___________________
PET DEPOSIT $ ___________ (NON-REFUNDABLE) PET FEE $ ____________
KEY FEE $_____________CLEANING FEE $_____________OTHER $______________
EVIDENCED BY: CASH __________ CHECK __________ CASHIER’S CHECK __________ MONEY ORDER _________
APPLICANT INFORMATION
APPLICANT: __________________________________________________________________________________________
HOME PHONE # ________________________________OTHER PHONE__________________________________________
EMAIL__________________________________________________________SSN#_________________________________
DL#__________________________ STATE_________ BIRTH DATE__________________
CURRENT ADDRESS: _____________________________________________________________________________________
CITY, STATE, ZIP________________________________________________________________________________________
LANDLORD NAME / MORTGAGE HOLDER: __________________________________ PAYMENT: __________________
PHONE # __________________ FAX # _______________________ EMAIL ADDRESS:_________________________
HOW LONG? _______________ (PLEASE CHECK ONE) OWNED OR RENT
REASON FOR LEAVING _________________________________________________________________________________
PRIOR STREET ADDRESS:_________________________________________________________________________________
CITY, STATE, ZIP________________________________________________________________________________________
LANDLORD NAME / MORTGAGE HOLDER: __________________________________ PAYMENT: __________________
PHONE # __________________ FAX # _______________________ EMAIL ADDRESS:_________________________
HOW LONG? _______________ (PLEASE CHECK ONE) OWNED ORRENT
REASON FOR LEAVING _________________________________________________________________________________
Page 1 of 5
CURRENT EMPLOYER: ___________________________________________________________________________________
HOW LONG? ____________________________ EMPLOYED AS _________________________________________________
ADDRESS: ______________________________________________________________________________________________
CITY, STATE, ZIP________________________________________________________________________________________
PHONE #____________________________________________FAX#_______________________________________________
SALARY: $_______________________ PER/MO SUPERVISOR: _______________________________________________
OTHER INCOME: SOURCE ______________________________________________________ AMOUNT: $_____________
PRIOR EMPLOYER (IF LESS THAN 3 YEARS): ______________________________________ PHONE # ________________
HOW LONG? ____________________________ EMPLOYED AS _________________________________________________
SALARY: $_______________________ PER/MO SUPERVISOR: _________________________________________
CREDIT REFERENCES: BANK ____________________________________________________ ACCT. # ________________
ADDRESS __________________________________________________________________________
PERSONAL REFERENCES:
1. NAME _______________________________________________ PHONE # _______________________________
EMAIL ________________________________ RELATIONSHIP _______________________________________
2. NAME _______________________________________________ PHONE # _______________________________
EMAIL ________________________________ RELATIONSHIP _______________________________________
CO-APPLICANT INFORMATION
CO-APPLICANT: _______________________________________________________________________________________
HOME PHONE # ________________________________OTHER PHONE__________________________________________
EMAIL__________________________________________________________SSN#_________________________________
DL#__________________________ STATE_________ BIRTH DATE__________________
CURRENT ADDRESS: _____________________________________________________________________________________
CITY, STATE, ZIP________________________________________________________________________________________
LANDLORD NAME / MORTGAGE HOLDER: __________________________________ PAYMENT: __________________
PHONE # __________________ FAX # _______________________ EMAIL ADDRESS:_________________________
HOW LONG? _______________ (PLEASE CHECK ONE) OWNED OR RENT
REASON FOR LEAVING _________________________________________________________________________________
PRIOR STREET ADDRESS:_________________________________________________________________________________
Applicants Initials: [_________] [_________]
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CITY, STATE, ZIP________________________________________________________________________________________
LANDLORD NAME / MORTGAGE HOLDER: __________________________________ PAYMENT: __________________
PHONE # __________________ FAX # _______________________ EMAIL ADDRESS:_________________________
HOW LONG? _______________ (PLEASE CHECK ONE) OWNED OR RENT
REASON FOR LEAVING _________________________________________________________________________________
CURRENT EMPLOYER: ___________________________________________________________________________________
HOW LONG? ____________________________ EMPLOYED AS _________________________________________________
ADDRESS: ______________________________________________________________________________________________
CITY, STATE, ZIP________________________________________________________________________________________
PHONE #____________________________________________FAX#_______________________________________________
SALARY: $_______________________ PER/MO SUPERVISOR: _______________________________________________
OTHER INCOME: SOURCE ______________________________________________________ AMOUNT: $_____________
PRIOR EMPLOYER (IF LESS THAN 3 YEARS): ______________________________________ PHONE # ________________
HOW LONG? ____________________________ EMPLOYED AS _________________________________________________
SALARY: $_______________________ PER/MO SUPERVISOR: _________________________________________
CREDIT REFERENCES: BANK ____________________________________________________ ACCT. # ________________
ADDRESS __________________________________________________________________________
PERSONAL REFERENCES:
1. NAME _______________________________________________ PHONE # _______________________________
EMAIL ________________________________ RELATIONSHIP _______________________________________
2. NAME _______________________________________________ PHONE # _______________________________
EMAIL ________________________________ RELATIONSHIP _______________________________________
VEHICLE INFORMATION
AUTOMOBILES:
MAKE ________________ MODEL__________________ LIC# _________________STATE______YR______COLOR______
MAKE ________________ MODEL__________________ LIC# _________________STATE______YR______COLOR______
MAKE ________________ MODEL__________________ LIC# _________________STATE______YR______COLOR______
Page 3 of 5
IN ADDITION TO APPLICANT(S), OTHER PERSONS TO BE AT PREMISES:
NAME RELATIONSHIP AGE OCCUPATION TELEPHONE NUMBER
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
PETS."3,8*5)"/9"/%&/5&35)&/6.#&30'1&54
PETS? (Y/N) _______ HOW MANY? Cats ________ Dogs _________ Other _________
IF YES, PLEASE COMPLETE THE PET APPLICATION AND SUBMIT IT WITH THE RENTAL APPLICATION.
OTHER INFORMATION
HAS ANY APPLICANT EVER FILED BANKRUPTCY? ___________ GIVE DETAILS ______________________________
________________________________________________________________________________________________________
HAS ANY APPLICANT EVER BEEN EVICTED? ___________ EXPLAIN ________________________________________
________________________________________________________________________________________________________
HAS ANY APPLICANT EVER WILLFULLY REFUSED TO PAY RENT WHEN DUE? ____________ EXPLAIN _________
________________________________________________________________________________________________________
HAS ANY APPLICANT OR OCCUPANT EVER BEEN CONVICTED OF A GROSS MISDEMEANOR OR FELONY?
YES_______ OR NO_______ IF YES PLEASE EXPLAIN________________________________________________________
________________________________________________________________________________________________________
HOW LONG DOES APPLICANT PLAN TO LIVE HERE? ________ DOES APPLICANT PLAN TO USE LIQUID FILLED
FURNITURE? _______TYPE ______________________________________________________________________________
DOES ANYONE IN THE HOUSEHOLD SMOKE? Y/N _______________
EMERGENCY CONTACT
APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY: __________________________________________________
RELATIONSHIP: ____________________________________________________ PHONE # ___________________________
CO-APPLICANT IN CASE OF EMERGENCY, PERSON TO NOTIFY: ______________________________________________
RELATIONSHIP: ____________________________________________________ PHONE # ___________________________
Page 4 of 5
OTHER OCCUPANTS
DISCLOSURE
PLEASE READ CAREFULLY BEFORE SIGNING
1. APPLICANT UNDERSTANDS THAT ________________________________________________________________ IS
THE LEASING AGENT AND REPRESENTATIVE FOR THE LANDLORD OF THE PREMISES LOCATED AT
_________________________________________________________________ AT A MONTHLY RENT OF $_____________.
2. APPLICANT DECLARES THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT, AND
APPLICANT AUTHORIZES AN EMPLOYMENT CHECK, CRIMINAL RECORDS CHECK, CREDIT CHECK, VERIFICATION
OF REFERENCES AND CURRENT AND PREVIOUS LANDLORDS.
3. APPLICANT HEREBY PAYS $_____________ AS A NON-REFUNDABLE APPLICATION FEE AND $____________
AS HOLDING FEE. IF APPLICANT IS DECLINED, THE HOLDING FEE MAY BE REFUNDED WITHIN ____ BUSINESS
DAYS. IF, AFTER APPROVAL, APPLICANT DECIDES NOT TO FULFILL THIS AGREEMENT BY COMPLETING
LEASE AND PAYING FIRST MONTHS RENT AND REMAINING SECURITY DEPOSIT, HOLDING FEE SHALL BE
RETAINED BY LANDLORD TO COVER ADMINISTRATIVE EXPENSES.
4. APPLICANT AGREES TO EXECUTE A RENTAL AGREEMENT BEFORE POSSESSION IS GIVEN AND TO PAY
THE RENT AND SECURITY DEPOSIT WITHIN ____ BUSINESS DAYS AFTER BEING NOTIFIED OF ACCEPTANCE OF
THIS APPLICANT.
5. LANDLORD AND AGENT WILL NOT BE BOUND BY ANY REPRESENTATIONS, AGREEMENTS OR
PROMISES, WRITTEN OR ORAL, MADE BY LANDLORD OR AGENT UNLESS CONTAINED IN THE RENTAL
AGREEMENT SIGNED BY LANDLORD OR LANDLORD’S AGENT.
6. APPLICANT HAS REVIEW ED THE PUBLIC RECORD INFORMATION ON THE ____________________
COUNTY RECORDER’S WEBSITE SHOWING THE POSSIBILITY OF PAST OR CURRENT LIENS RECORDED AGAINST THE
PROPERTY AS OF THE DATE OF THIS APPLICATION. APPLICANT AGREES TO LEASE THE PROPERTY SUBJECT TO
THIS INFORMATION, AND HOLD THE LANDLORD AND ITS AGENTS HARMLESS BASED UPON THIS INFORMATION
AND FUTURE USE OF THE PROPERTY.
7. APPLICANT DOES HEREBY RELEASE LANDLORD, AGENT AND THIS COMPANY FROM ANY AND
ALL DAMAGES OR LIABILITIES W HICH MIGHT RESULT FROM THE ABOVE INFORMATION. APPLICANT
RELEASES PRESENT LANDLORD AND ALL PREVIOUS LANDLORDS FROM ANY AND ALL LIABILITY FOR ANY
DAMAGE OR INJURY WHATSOEVER CAUSED BY PROVIDING INFORMATION TO LANDLORD OR AGENT REGARDING
APPLICANT.
8. APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT A FALSE STATEMENT MADE HEREIN IS GROUNDS
FOR DENIAL OF RENTAL TO APPLICANT. ANY STATEMENT HEREIN MAY BE CONSTRUED AS A
CONDITION PRECEDENT TO ANY BINDING RENTAL AGREEMENT OR CONTRACT BETWEEN APPLICANT AND
LANDLORD.
9. APPROVAL FOR RESIDENCY IS MADE W ITHOUT REGARD TO RACE, COLOR, RELIGION, SEX,
NATIONAL ORIGIN, AGE, GENDER IDENTITY OR EXPRESSION, FAMILIAL STATUS, SEXUAL ORIENTATION,
ANCESTRY, OR HANDICAP..
10. APPLICANT UNDERSTANDS THAT APPLICANT ACQUIRES NO RIGHTS TO PREMISES UNTIL EXECUTION OF A
RENTAL AGREEMENT IN THE FORM SUBMITTED AND DEPOSIT OF RENT AND SECURITY DESCRIBED ABOVE.
SIGNATURE OF APPLICANT ________________________________________ DATE ____________ TIME ____________
SIGNATURE OF CO-APPLICANT _____________________________________ DATE ____________ TIME ____________
OFFICE USE ONLY:
REFERRAL COMPANY _______________________________________ MLS # _______________ DATE PAID __________
AGENT:______________________________________P.I.D#____________________ LICENSE # ______________________
Page 5 of 5
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