APPLICATION TO RENT
Separate application required for each adult occupant (All sections must be completed)
Last Name ______________________________ First Name Middle
Other name(s) known by in past:
Date of Birth / / Soc. Sec. # ______/_______/__________ Driver’s License # State
Marital Status: (circle one) single married divorced separated
Cell Phone ________________________ Cell Carrier _______________________ Email: _______________________________________
Home Phone ______________________ Work Phone ______________________ Facebook/Blog/Myspace:________________________
List all other persons who will be occupants under the age of 18:
Full Name Age Date of Birth Soc. Sec. # Relationship to you
Emergency Contact: Relationship: Phone(s):
Email:
Rental History:
Current address City State Zip
Current address is: parent’s home own home rent home rent apartment student housing friend
Landlord’s name phone ( )
Date In: Date Out: Monthly payment $
Reason for Leaving
Previous Address City State Zip
Previous address is: parent’s home owned home rented home rented apartment student housing friend
Landlord’s name phone ( )
Date In: Date Out: Monthly payment $
Reason for Leaving
Employment:
Present Occupation Employer Name
How Long? Name of Supervisor Phone # ( )
Address City State Zip
Current Monthly Gross Income $
How often are you paid? (circle one) weekly bi-weekly semi-monthly monthly
Prior Occupation Employer Name
How Long? Name of Supervisor Phone # ( )
Address City State Zip
Financial:
Name of Bank Address Account No.
Check all that apply: Checking Savings Visa Loan
Credit Card Type Bank/Issuer Number Expires _____/_____
List Financial Obligations:
Creditor Name Address Phone # Monthly Payment
Have you ever been arrested, accused, charged or convicted of any crime? No Yes If yes, please explain each crime in detail:
Have you ever filed for Bankruptcy? No Yes (If yes, please give date filed , and in which state? )
Has an eviction action ever been filed against you? No Yes (if yes, what is the status of the case?
Do you smoke? Do you have any pets? If yes, which breed and size?
Applicant represents that all of the above statements are true and correct and hereby authorizes verification of the above items including but not limited to
the obtaining of credit reports and agrees to furnish additional credit references on request. Applicant also affirms that all occupants of the leased
premises are and will be legally residing in the United States.
Applicant signature Date
All applications will be reviewed in the order received and judged
based on the above criteria. Owner does not discriminate on the basis
of race, color, religion, gender, national origin, disability, familial status
or source of income.
