383 N State St #101

Orem, UT 84057
P: 385-985-3848
hbreassistant@gmail.com
HomeBasicsRealEstate.net

RENTAL APPLICATION
Incomplete forms will not be considered.
All applicants over 18 years old must complete a separate application and pay the application fee.
APPLICANTS ARE REQUIRED TO PAY A $25.00 non-refundable PROCESSING FEE.
DATE: ___________ DATE NEEDED: __________UNIT ADDRESS: __________________________________________

APPLICANT NAME: ___________________________________________________________________________________________

SOCIAL SECURITY NUMBER:____________________________________ DATE OF BIRTH: ______________________________

CONTACT NUMBER:____________________________________________ OTHER #:_____________________________________

EMAIL: ________________________________________________________________________________________________________

DRIVERS LICENSE NUMBER:_________________________________________ STATE ISSUED:___________________________

CURRENT ADDRESS:
ADDRESS: ____________________________________________CITY: ______________________STATE: _______ ZIP: ____________
LANDLORDS NAME: ____________________________________________LANDLORDS PHONE: __________________________
DATE IN: ___________________DATE OUT: ___________________MONTHLY RENTAL AMOUNT $: ______________________
REASON FOR LEAVING: _________________________________________________________________________________________

PREVIOUS ADDRESSES (if current address is less than 5 years):

ADDRESS: ____________________________________________CITY: ______________________STATE: _______ ZIP: ____________
LANDLORDS NAME: ____________________________________________LANDLORDS PHONE: __________________________
DATE IN: ___________________DATE OUT: ___________________MONTHLY RENTAL AMOUNT $: ______________________
REASON FOR LEAVING: _________________________________________________________________________________________

ADDRESS: ____________________________________________CITY: ______________________STATE: _______ ZIP: ____________

LANDLORDS NAME: ____________________________________________LANDLORDS PHONE: __________________________
DATE IN: ___________________DATE OUT: ___________________MONTHLY RENTAL AMOUNT $: ______________________
REASON FOR LEAVING: _________________________________________________________________________________________

NAMES OF OTHER OCCUPANTS (under age 18) AGE DATE OF BIRTH

HAVE YOU OR ANY OTHER OCCUPANTS EVER:

FILED FOR BANKRUPTCY: Yes No (If yes) WHAT YEAR:____________________________________

BEEN SERVED AN EVICTION NOTICE: Yes No REASON:_____________________________________________
BEEN ASKED TO LEAVE A PROPERTY: Yes No REASON:_____________________________________________
ARE YOU IN THE MILITARY: Yes No
ARE YOU LIVING IN THE US LEGALLY: Yes No
DO YOU SMOKE? Yes No
DO YOU HAVE ANY PETS? Yes No WHAT KIND:_________________________________________
 383 N State St #101
Orem, UT 84057
P: 385-985-3848
hbreassistant@gmail.com
HomeBasicsRealEstate.net
APPLICANT CURRENT EMPLOYMENT:
EMPLOYER: __________________________________________________________________________________________
EMPLOYERS ADDRESS: _______________________________________________________________________________
POSITION: ___________________ MONTHLY SALARY $: _____________ LENGTH OF EMPLOYMENT:____________
SUPERVISOR:_________________________________________CONTACT #: ____________________________________

PREVIOUS EMPLOYMENT (if current job is less than 3 years):

EMPLOYER: __________________________________________________________________________________________
EMPLOYERS ADDRESS: _______________________________________________________________________________
POSITION: ___________________ MONTHLY SALARY $: _____________ LENGTH OF EMPLOYMENT:____________
SUPERVISOR:_________________________________________CONTACT #: ____________________________________

IN CASE OF EMERGENCY NOTIFY:

NAME: _______________________________________________________________________________________
RELATIONSHIP: __________________________________ PHONE:____________________________________
NAME: _______________________________________________________________________________________
RELATIONSHIP: __________________________________ PHONE:____________________________________

PERSON REFERENCES:
*We contact every reference! Please inform your references that we will be calling so they know to expect the call. The faster they
respond the quicker the application process goes.

NAME: ____________________________PHONE: _______________________________LENGTH OF ACQUANTANCE: ____________

NAME: ____________________________PHONE: _______________________________LENGTH OF ACQUANTANCE: ____________

VEHICLE INFORMATION:
MAKE/MODEL: ______________________YEAR:__________ COLOR:___________ LICENSE NUMBER:_____________________
MAKE/MODEL: ______________________YEAR:__________ COLOR:___________ LICENSE NUMBER:_____________________

PERSONAL BANKING INFORMATION:

BANK:________________________________________________________________________________________________
CHECKING ACCOUNT #:______________________________ROUTING #:_____________________________________

APPLICANT REPRESENTS THAT ALL OF THE ABOVE STATEMENTS ARE TRUE AND CORRECT AND HEREBY AUTHORIZES VERIFICATION OF THE
ABOVE ITEMS INCLUDING BUT NOT LIMITED TO THE OBTAINING OF CREDIT REPORT AND AGREES TO FURNISH ADDITIONAL CREDIT
REFERENCES ON REQUEST.

THE UNDERSIGNED MAKES APPLICATION TO RENT HOUSING ACCOMODATIONS LISTED ABOVE FOR RENTS OF $____________ PER MONTH AND
UPON APPROVAL OF THIS APPLICATION AGREES TO SIGN A RENTAL OR LEASE AGREEMENT AND TO PAY ALL SUMS DUE,
INCLUDINGDEPOSITS, BEFORE OCCUPANCY.

______________________________________________________________________________________
SIGNNATURE DATE

Home Basics Real Estate supports, and is committed to equal housing opportunity. We do not discriminate against anyone on the basis of
race, color, religion, sex, disability, familial status, national origin, or source of income.