Name Phone Number Relationship
Have you ever been late or delinquent on rent?
Have you ever been party to a lawsuit?
Do you smoke?
Do you have any pets?
If yes, list type, breed, weight, and age.
If yes to any of the above, please explain why.
Why are you moving from your current address?
Is there anything negative in your credit or background check you want to comment on?
Rental application fee: $ ______.______ Paid
Agreement & Authorization
By signing this application, I verify that the statements in this application are true and correct. I authorize the use of the
information and contacts provided to complete a credit, reference, and/or background check. I understand that false or
lack of information may result in the rejection of this application.
Signature of applicant: Date:
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