APPLICATION TO RENT - Complete a separate application for each adult tenant.

PERSONAL INFO
_______________________________ _________________________________ _________________________________________________________
FIRST NAME

LAST NAME

EMAIL ADDRESS

_______________________________ ________________________ ________________________________ __________________________ _____

CELL

DATE OF BIRTH

SOCIAL SECURITY

DRIVERS LICENSE / ID

STATE

RESIDENCE HISTORY - PLEASE PROVIDE 5 YEARS OF RESIDENTIAL HISTORY. USE THE BACK OF THIS PAGE IF NECESSARY.
_________________________________________________ _____________________ _________ ____________ ______________ ______________
CURRENT ADDRESS

CITY

_____________________________

STATE

ZIP

FROM/TO

RENT AMOUNT

_____________________________ _____________________________ _____________________________

LANDLORD NAME

LANDLORD PHONE

LANDLORD EMAIL

REASON FOR LEAVING

PREVIOUS RESIDENCE
_________________________________________________ _____________________ _________ ____________ ______________ ______________
PREVIOUS ADDRESS

_____________________________

CITY

STATE

ZIP

FROM/TO

RENT AMOUNT

_____________________________ _____________________________ _____________________________

LANDLORD NAME

LANDLORD PHONE

LANDLORD EMAIL

REASON FOR LEAVING

_________________________________________________ _____________________ _________ ____________ ______________ ______________

SECOND PREVIOUS ADDRESS

_____________________________

CITY

STATE

ZIP

FROM/TO

RENT AMOUNT

_____________________________ _____________________________ _____________________________

LANDLORD NAME

LANDLORD PHONE

LANDLORD EMAIL

REASON FOR LEAVING

EMPLOYMENT HISTORY - PLEASE PROVIDE 5 YEARS OF EMPLOYMENT HISTORY. USE THE BACK OF THIS PAGE IF NECESSARY.
CURRENT EMPLOYMENT
____________________________ _____________________________ ____________________ _______________________ ___________________
CURRENT EMPLOYER

CONTACT PERSON/ SUPERVISOR

CONTACT PHONE

YOUR TITLE/ROLE/POSITION

TYPE OF BUSINESS

_______________________________________ _________________ _______ ___________ ____________________ ____________________

EMPLOYER ADDRESS

CITY

STATE

ZIP

FROM/TO DATES

SALARY

PREVIOUS EMPLOYMENT
____________________________ _____________________________ ____________________ _______________________ ___________________
PREVIOUS EMPLOYER

CONTACT PERSON/ SUPERVISOR

CONTACT PHONE

YOUR TITLE/ROLE/POSITION

TYPE OF BUSINESS

_______________________________________ _________________ _______ ___________ ____________________ ____________________

EMPLOYER ADDRESS

CITY

STATE

ZIP

FROM/TO DATES

SALARY

____________________________ _____________________________ ____________________ _______________________ ___________________

SECOND PREVIOUS EMPLOYER

CONTACT PERSON/ SUPERVISOR

CONTACT PHONE

YOUR TITLE/ROLE/POSITION

TYPE OF BUSINESS

_______________________________________ _________________ _______ ___________ ____________________ ____________________

EMPLOYER ADDRESS

CITY

Please answer the following questions.

STATE

Answer one.

1. Have you ever had any credit problems?

Yes / No

2. Have you ever had an unlawful detainer filed against you?

Yes / No

3. Have you ever been evicted from tenancy?

Yes / No

4. Have you ever declared bankruptcy in the past 7 years?

Yes / No

5. Have you ever been convicted of a felony?

Yes / No

6. Do you have pets?

Yes / No

7. Will you be using any water-filled furniture in your residence?

Yes / No

8. Have you ever intentionally refused to pay rent?

Yes / No

9. Do you have any musical instruments?

Yes / No

10. Do you smoke?

Yes / No

11. Have you ever owned or rented a house before? (vs. apt)

Yes / No

12. Have you ever rented/owned a home with a pool before?

Yes / No

ZIP

FROM/TO DATES

SALARY

Please explain.

I warrant that all statements contained in this

application are true and accurate and that I have
not knowingly withheld any information which
would, if disclosed, affect my application
unfavorably. APPLICANT UNDERSTANDS AND
AGREES THAT ANY MISREPRESENTATION
AND/OR OMISSION IS GROUNDS FOR
EVICTION. I hereby provide the owner or its
authorized agent with my consent to
communicate with my current and former
landlords, as well as my current employer(s) for
the purpose of, among other things, verifying the
information listed herein. I am aware that a credit
history, eviction search, and criminal background
check may be conducted in conjunction with my
application.
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APPLICATION TO RENT - Complete a separate application for each adult tenant.

WHEN DO YOU PLAN TO MOVE IN? Date: _____________________________________
I hereby apply to rent/lease HOUSE at ____________________________________________________________
_________________________________________________________________________________________________________________
for $ ____________________ per month and upon approval of my Application and signed Rental Agreement, I agree to pay the first month's rent of
$ _________________ , a security deposit in the amount of $_____________, and last months rent of $_____________. I understand that this is a
______-year lease that I am applying for.
Applicant Signature _________________________________________________________

Date ___________________________

For the purposes of credit & rent liability only: LIST ALL ADDITIONAL ADULTS AND OCCUPANTS UNDER THE AGE OF 18. Please put "F" for full time
or "P" for part time after each name.
Please place an X to indicate if there will be no additional occupants: ______
Name _______________________________________________ Age ________ Birthdate ___ /___ /___ Relationship ___________________________
Name _______________________________________________ Age ________ Birthdate ___ /___ /___ Relationship ___________________________

Name _______________________________________________ Age ________ Birthdate ___ /___ /___ Relationship ___________________________
Name _______________________________________________ Age ________ Birthdate ___ /___ /___ Relationship ___________________________
* Please note: All adult applicants must submit an individual application. In the case of several applicants applying to share the same household,

INCOME VERIFICATION
BANKING INFORMATION
Name of Bank/S&L/Credit Union _________________________ Branch or Address ____________________________
Checking #: ___________________________ Approx. Bal. _______________ Savings #: ___________________________ Approx. Bal. _______________
Name of Bank/S&L/Credit Union _________________________ Branch or Address ____________________________
Checking #: ___________________________ Approx. Bal. _______________ Savings #: ___________________________ Approx. Bal. _______________
Other sources of income ________________________________________________________________________________________________

CREDIT REFERENCES (Credit Cards/Car Payments/Other Loans)

Company Name ______________________________________ Address/City: __________________________________________________________________
Account #: _________________________________ Present Balance _______________________ Monthly Payment: ______________
Company Name ______________________________________ Address/City: __________________________________________________________________
Account #: _________________________________ Present Balance _______________________ Monthly Payment: ______________
Company Name ______________________________________ Address/City: __________________________________________________________________
Account #: _________________________________ Present Balance _______________________ Monthly Payment: ______________
Company Name ______________________________________ Address/City: __________________________________________________________________
Account #: _________________________________ Present Balance ______________________ Monthly Payment: ______________

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APPLICATION TO RENT - Complete a separate application for each adult tenant.

EMERGENCY CONTACT
Name: ______________________________________ Address __________________________________________________________________
Relationship ___________________________________________________________ Phone (_______) ________________________________

VEHICLES YOU INTEND TO BRING TO THIS RESIDENCE (Operable Automobiles including Trucks, Vans, Motorcycles)
Are you the registered owner?

Yes No

If not, who?__________________________________________________________________________________

Year _________ Make ___________________ Model _________________ Color _________________ License # ________________________ State ________

Are you the registered owner?

Yes No

If not, who?__________________________________________________________________________________

Year _________ Make ___________________ Model _________________ Color _________________ License # ________________________ State ________

Are you the registered owner?

Yes No

If not, who?__________________________________________________________________________________

Year _________ Make ___________________ Model _________________ Color _________________ License # ________________________ State ________

REFERENCES - TWO (2) PERSONAL REFERENCES

_________________________________ _________________________________ _________________
FIRST AND LAST NAME
RELATIONSHIP
HOW LONG KNOWN?

(______)____________________
PHONE

_________________________________ _________________________________ _________________

FIRST AND LAST NAME
RELATIONSHIP
HOW LONG KNOWN?

(______)____________________
PHONE

REFERENCES - TWO (2) PROFESSIONAL REFERENCES

_________________________________ _________________________________ _________________
FIRST AND LAST NAME
RELATIONSHIP
HOW LONG KNOWN?

(______)____________________
PHONE

_________________________________ _________________________________ _________________

FIRST AND LAST NAME
RELATIONSHIP
HOW LONG KNOWN?

(______)____________________
PHONE

Please mark the box with an X

I have attached two copies of identification (Drivers license, State issued ID, Passport, or Social Security
Card are acceptable)
I have attached my $35 applicant screening fee (each individual adult applicant must submit an application
fee, either as a money order or cashiers check.) I also understand that this fee is non-refundable. Only if I
have been selected and decide to enter the rental/lease agreement will this amount in applicant fees be
credited to the first months rent.

Please submit your completed application, in-person.

Thank you.

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