Rental Application
Separate application required from each applicant age 18 or older.
Date and time received by landlord 	
Credit check fee 	 Received 	

This section to be completed by landlord
Address of Property to Be Rented: 	
Rental Term:  [  ] month-to-month  [  ] lease from 	 to 	
Amounts Due Prior to Occupancy
First month’s rent 	$	
Security deposit 	$	
Other (specify): 	 $	
	 TOTAL	 $		
Applicant
Full Name—include all names you use(d): 	
Home Phone: 	 Work Phone: 	
Cell Phone: 	 Email: 	
Fax:*	 Social Security Number: 	
Driver’s License Number/State: 	
Other Identifying Information: 	
Vehicle Make: 	 Model: 	 Color: 	
Year: 	 License Plate Number/State: 	
Additional Occupants
List everyone, including minor children, who will live with you:
Full Name 	Relationship to Applicant	

		

Rental History
First-Time Renters: Attach a description of your housing situation for the past five years.
Current Address: 	
Dates Lived at Address: 	 Rent $ 	 Security Deposit $ 	
Landlord/Manager: 	
Landlord/Manager’s Phone: 	
Reason for Leaving: 	
* By providing this fax number I agree to receive facsimile advertisements from the landlord or management company.
Previous Address: 	
Dates Lived at Address: 	 Rent $ 	 Security Deposit $ 	
Landlord/Manager: 	
Landlord/Manager’s Phone: 	
Reason for Leaving: 	

Previous Address: 	
Dates Lived at Address: 	 Rent $ 	 Security Deposit $ 	
Landlord/Manager: 	
Landlord/Manager’s Phone: 	
Reason for Leaving: 	
Employment History 
Self-employed applicants: attach tax returns for the past two years.
Name and Address of Current Employer: 	
	 Phone: (         ) 	
Name of Supervisor: 	 Supervisor’s Phone: (         ) 	
Dates Employed at This Job: 	 Position or Title: 	
Name and Address of Previous Employer: 	
	 Phone: (         ) 	
Name of Supervisor: 	 Supervisor’s Phone: (         ) 	
Dates Employed at This Job: 	 Position or Title: 	
Attach pay stubs for the past two years, from this employer or prior employers.
Income
1.	Your gross monthly employment income (before deductions): 	 $	
2.	Average monthly amounts of other income (specify sources): 	 $	
		 $	
		 $	
TOTAL: 	 $	
Bank/Financial Accounts
	Account Number	Bank/Institution	Branch
Savings Account: 	
Money Market or Similar Account: 	

	

Credit Card Accounts
Major Credit Card:   [  ] VISA   [  ] MC   [  ] Discover Card   [  ] Am Ex   [  ] Other: 	
Issuer: 	Account No. 	
Balance $	Average Monthly Payment $ 	

Major Credit Card:   [  ] VISA   [  ] MC   [  ] Discover Card   [  ] Am Ex   [  ] Other: 	
Issuer: 	Account No. 	
Balance $	Average Monthly Payment $ 	
Loans
Type of Loan (mortgage, car, student loan, etc.)	Name of Creditor 	Account Number	Amount Owed	Monthly Payment	

					

					

Other Major Obligations
Type	Payee	Amount Owed	Monthly Payment	

				

Miscellaneous
Describe the number and type of pets you want to have in the rental property: 		 . 
Describe water-filled furniture you want to have in the rental property: 		 . 
Do you smoke?	  [  ] yes 	  [  ] no
Have you ever:	Filed for bankruptcy? 	  	[  ] yes	  [  ] no	How many times 	
	Been sued? 	 	[  ] yes	  [  ] no	How many times 	
	Sued someone else?	  	[  ] yes	  [  ] no	How many times 	
	Been evicted? 	  	[  ] yes	  [  ] no	How many times 	
	Been convicted of a crime?	[  ] yes	  [  ] no	How many times 	

Explain any “yes” listed above: 	

References and Emergency Contact
Personal Reference: 	 Relationship: 	
Address: 	
	 Phone: (         ) 	

Personal Reference: 	 Relationship: 	
Address: 	
	 Phone: (         ) 	

Contact in Emergency: 	 Relationship: 	
Address: 	
	 Phone: (         ) 	
Source
Where did you learn of this vacancy? 	
	
I certify that all the information given above is true and correct and understand that my lease or rental agreement may be terminated if I have made any material false or incomplete statements in this application. I authorize verification of the information provided in this application from my credit sources, credit bureaus, current and previous landlords and employers, and personal references. This permission will survive the expiration of my tenancy.

Applicant	 Date 	

Notes (Landlord/Manager):