RESIDENTIAL RENTAL APPLICATION
Today’s Date
Date of anticipated move in
Property address
Monthly rent Security deposit Pet deposit
Applicant
Full name of applicant
Present Address
Telephone number (home) (work)
D.O.B. social security # Driver’s license
Applicant’s employment
Name of present employer
Address
Position Date started Monthly income
Supervisor’s name phone
Name of previous employer
Address
Position Date started Monthly income
Supervisor’s name phone
Other sources of income
Spouse
Full name of spouse
Present Address
Telephone number (home) (work)
D.O.B. social security # Driver’s license
Spouse’s employment
Name of present employer
Address
Position Date started Monthly income
Supervisor’s name phone
Name of previous employer
Address
Position Date started Monthly income
Supervisor’s name phone
Other sources of income
Present Landlord or mortgage company
Present Landlord or mortgage company
Telephone number (home) (work)
Monthly rent or mortgage payment Date of move-in Date of move-out
Previous Landlord or mortgage company
Previous Landlord or mortgage company
Telephone number (home) (work)
Monthly rent or mortgage payment Date of move-in Date of move-out
Personal References
Name phone
Address
Name phone
Address
Emergency
In case of emergency contact
Relationship phone
Occupants
List all occupants
Pets
List any pets: type breed weight age
List any pets: type breed weight age
Vehicles
List vehicles to be parked at premises:
make model year
make model year
Credit/Criminal History
Bank name phone
Address
Checking account number
List all credit obligations with minimum monthly payment:
Have any of the occupants listed above ever been: convicted of a felony? received deferred adjudication for a
felony? been evicted? broken a lease? declared bankruptcy?
The above listed applicant declares that all statements made in this application are true and complete. Applicant hereby
authorizes the National Association of Independent Landlords to verify all of the information in this application and obtain
credit reports on the above listed applicant and/or applicant’s. If applicant or applicant’s spouse has given any false
information Landlord is entitled to reject the application, and retain all application fees as liquidated damages for Landlord’s
time and expenses in processing this application. Applicant shall give the Landlord a nonrefundable application fee to be paid
in the amount of $
Signature of applicant Date
Signature of Spouse Date
Signature of Landlord or Landlord’s agent Date
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