Applicant information
Name: First Middle Last Birth date Social security #
Email address: Home phone Cell phone
Driver’s license #
All other occupants (under 18): Birth date Relationship to applicant
Rental history
Current residence
Address City State ZIP
Monthly rent Dates of residency (From/To) Reason for moving
Owner/Manager’s name Phone number
Previous residence
Address City State ZIP
Monthly rent Dates of residency (From/To) Reason for moving
Owner/Manager’s name Phone number
Employment history
Current employer Occupation
Employer address Employer’s phone Dates of employment
Name of supervisor Monthly pay
Previous employer Occupation
Employer address Employer’s phone Dates of employment
Name of supervisor Monthly pay
Credit history
Bank/Institution Balance on deposit or Balance owed
Checking account
Savings account
Credit card
Auto loan
Additional debt:
Rental Application
References
Name Phone Number Relationship
General information
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
Additional questions:
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:
Yes No
Yes No
Yes No
Yes No
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