APPLICANT #1 Last Name First Middle BIRTHDATE DRIVER'S LICENSE # and STATE Soc. Sec. #
APPLICANT #2 Last Name First Middle BIRTHDATE DRIVER'S LICENSE # and STATE Soc. Sec. #
Other 1
FULL NAME RELATIONSHIP TO APPLICANT DATE OF BIRTH SOCIAL SECURITY NUMBER
Total # of occupants:
Persons 2
Do you have a waterbed?
to 3 ( ) Yes ( ) No
Do you have renter's insurance ?
occupy 4 ( ) Yes ( ) No
Company:
rental 5 Do you have a pet ?
( ) Yes ( ) No
property 6
Type/weight
PART 1 RESIDENT HISTORY (2 YEARS)
APPLICANT #1 Present Address City State Zip
How Long? ( ) Own Phone Monthly Payment
from______ to______ ( ) Rent $
Name of Present Landlord/Mortgage Co. City State Zip Day Phone Night Phone
( ) ( )
PART 2 PREVIOUS RESIDENCE HISTORY (2 YEARS)
APPLICANT #1 Previous Address City State Zip
How Long? ( ) Own Phone Monthly Payment
from______ to______ ( ) Rent ( ) $
Name of Present Landlord/Mortgage Co. City State Zip Day Phone Night Phone
( ) ( )
APPLICANT #2 Previous Address City State Zip
How Long? ( ) Own Phone Monthly Payment
from______ to______ ( ) Rent ( ) $
Name of Present Landlord/Mortgage Co. City State Zip Day Phone Night Phone
( ) ( )
PART 3 EMPLOYMENT HISTORY (2 YEARS)
APPLICANT #1 Employed By Department Supervisor's Name/Co.
How Long?
from______ to______
Address City State Phone Position Held/Occupation Monthly Salary
( ) $
APPLICANT #2 Employed By Department Zip Supervisor's Name/Co.
How Long?
from______ to______
Address City State Zip Phone Position Held/Occupation Monthly Salary
( ) $
APPLICANT Employed By Department Supervisor's Name/Co.
How Long?
from______ to______
Address City State Zip Phone Position Held/Occupation Monthly Salary
( ) $
ADDITIONAL INCOME: Additional income such as child support, alimony or separate maintenance need not be disclosed unless such Additional Income is to be included for qualification hereunder.
Source: Amount of $_______________________per__________________. Source _________________________________________________________________________________________
PART 4 IMPORTANT INFORMATION
AUTO #1 (Year, Make, Model, Color) License Plate State Payment Made to: Monthly Payment
$
AUTO #2 (Year, Make, Model, Color) License Plate State Payment Made to: Monthly Payment
$
Name of APPLICANT'S nearest Relative Relationship Address City State Zip Phone
( )
Emergency Contact Relationship Address City State Zip Phone
( )
Personal Reference Relationship Address City State Zip Phone
( )
Page 1 of 2
Rental Application
NON-REFUNDABLE APPLICATION FEE $______ per adult
In compliance with the State and Federal laws, this is to inform you that an investigation involving the statements made on your
r
ental application for residency at the above mentioned apartment community is being initiated.
Have you or any family member or other person planning to reside in our community ever filed bankruptcy?
YES______________ NO ________________
Have you or any family member or other person planning to reside in our community ever been convicted of any felony or
misdemeanor offense?
YES______________ NO ________________
Have you or any family member or other person planning to reside in our community ever been convicted pled guilty or "No Contest"
to a sexual offense?
YES______________ NO ________________
HAVE YOU EVER BEEN EVICTED?
YES______________ NO ________________
I/We are aware that an incomplete application causes a delay in processing and may result in denial of this application for tenancy.
In addition, applicant has paid $____________ holding deposit to agent to hold an apartment available from date of application to date of lease initiation.
In no event shall this period exceed 30 days. In the event this application is not approved by the owner or the applicant withdraws the application within
72 hours of the date of deposit, the $____________ holding deposit shall be refunded. After that initial 72 hours period expires, it is understood that
should applicant refuse to sign the lease or occupy the premises on the agreed upon date, the holding deposit is thereby forfeited. Upon occupying the
premises, the $___________ holding deposit may be applied to any amounts owing at that time, such as rent due, security deposits, etc.
It is acknowledged and agreed that during the tenancy all persons occupying the premises will be legally residing within the United States.
Signed_____________________________________________ Signed________________________________________________ Dated _________________
Applicant #1 Applicant #2
Signed_____________________________________________ Title________________________________________________ Dated _________________
Agent for Owner
How did
y
ou hear about our A
p
artments?
_________________________
__________________________________________________________
I was referred by
[ ] Frien
d
[ ] Resident
If Resident, Name ___________________________________________ Apt#_____________________________
I/We certify that to the best of my/our knowledge all statements are true and complete. I/We further authorize __________________ Apartments to obtain credit
reports, character reports, verification of rental history, income history, IRS Income taxes, pension verifications, bank verifications and employment history as necessary
to verify all information put forth in the above referenced application for residency. Faults, fraudulent or misleading information may be grounds for denial of residency or
subsequent eviction.
EQUAL HOUSING
OPPORTUNITY
Page 2 of 2
APPLICATION QUALIFICATION FORM
Several criteria are considered while determining whether to approve a new tenant. Many of these criteria are built into a process.
Checks may be made on the prospective tenant’s employment or other sources of income, credit history, criminal history, rental history,
references, credit sources, banks and other financial institutions, and previous employers. While not all of these are checked on each
prospective tenant, you should be prepared to disclose all of the above information and have it checked and verified.
The undersigned prospective tenants certify and warrant that:
1. All of the prospective tenants have verifiable sources of income, verifiable past rental history, and verifiable credit and
references, each occupant/tenant/resident is residing in the United States legally, and that the information above is accurate.
2. None of the prospective tenants/occupants (even minors) have ever been evicted from a premises, have a current outstanding
judgment, have left a previous landlord owing money, or have left a prior rental premises under threat of eviction.
3. None of the prospective tenants/occupants (even minors) have ever filed for bankruptcy protection whether or not the
bankruptcy was discharged or dismissed, have a current pending bankruptcy case, or have met with a bankruptcy attorney in the last two
years. If any have filed or met with a bankruptcy attorney, please give details (include date of bankruptcy, attorney name, etc.):
4. None of the above prospective tenants/occupants (even minors) have ever been convicted any crime other than a minor traffic
violation, except those disclosed below (include type of criminal act, place of occurrence, date of occurrence, resulting action, and current
status (probation, parole, etc.):
5. None of the prospective tenants/occupants (even minors) have ever committed, been indicted, arrested, investigated, or
otherwise detained for any criminal act (other than a minor traffic infraction); except those disclosed below (include type of criminal act,
place of occurrence, date of occurrence, resulting action, and current status (probation, parole, etc.):
In the event Owner/Landlord proceeds with an application and it is determined that the prospective tenants have been
untruthful in any of the above statements, each undersigned prospective tenant agrees to pay to Landlord the actual costs incurred in
processing the application and an administrative fee of $100.00.
The Undersigned represent that all of the above statements are True and Complete and hereby AUTHORIZE VERIFICATION
OF SUCH INFORMATION . Authorization is given to contact any REFERENCES, BANK, PRIOR LANDLORDS, PRIOR/CURRENT
EMPLOYERS, GOVERNMENTAL AGENCIES, AND FAMILY. Further authority is given to check all CREDIT AND PUBLIC
RECORD INFORMATION. Applicants release ALL liability or responsibility, from all person or corporations that request or supply
such information. Applicant acknowledges that FALSE information herein will constitute grounds for: (1) Rejection of an application,
(2) Termination of residents right to OCCUPANCY and eviction. False information may also constitute a serious offense under the laws
of the state.
Dated this
Signature Print Name SS #
Signature Print Name SS #
Signature Print Name SS #
© Kirk A. Cullimore 5/2008 This form may not be reproduced without express written permission.