Rental / Credit Application

PERSONAL INFORMATION

Date ___________________________________________ Interviewed By _______________________________________________

Name of Applicant _________________________________________________ Date of Birth ________________________________

E-mail____________________________________________Telephone___________________________________________________________

Social Sec. No. ________________________________________________ Driver’s License No. _________________________________

Present Address _________________________________________ City _____________________ State _________ Zip ___________

Prior Address _________________________________________ City _____________________ State _________ Zip____________

How long have you lived at present address?_________________ How long have you lived at prior address? _________________________

Name of Landlord __________________________________________ Telephone __________________________________________

Prior Landlord_____________________________________________Telephone _____________________________________________

How many will be living in this unit? Adults_____________ Children ____________ Pets ___________ Weight of pets ____________

Employer _________________________________________ Occupation ___________________________ Current Salary __________

How long?____________________________ Contact Person ____________________________Telephone ________________________

SPOUSE INFORMATION

Name of Spouse __________________________________________ Date of Birth ______________ Telephone __________________

Social Sec.No.__________________________________________ Driver’s License No._________________________________________

Employer ____________________________ Occupation ____________________________ Current Salary ________________________

How long? ____________________________ Contact Person ____________________________ Telephone _____________________

Has your spouse ever filed for bankruptcy? q Yes q No

BANK INFORMATION

Bank Name _________________________________________________ Branch ___________________Telephone _________________

Address ___________________________________________________________________________________________________
Checking Account No. ________________________________ Savings Account No. _______________________________________

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 PERSONAL / CREDIT REFERENCES

NAME RELATIONSHIP TELEPHONE

_____________________________________________ ___________________________________ ___________________
_____________________________________________ ___________________________________ ___________________
_____________________________________________ ___________________________________ ___________________
CREDIT GRANTOR ADDRESS TELEPHONE
_____________________________________________ ___________________________________ ___________________
_____________________________________________ ___________________________________ ___________________
_____________________________________________ ___________________________________ ___________________
_____________________________________________ ___________________________________ ___________________
_____________________________________________ ___________________________________ ___________________

OTHER INFORMATION

Number of vehicles (including company cars) _______________________________________________________________________

Make/Model______________________________________ Year_______ Color __________ Tag No. ______________ State _______

Make/Model______________________________________ Year_______ Color __________ Tag No. ______________ State _______

Make/Model______________________________________ Year_______ Color __________ Tag No. ______________ State _______

HAVE YOU EVER

Filed for bankruptcy q Yes q No If yes, when? ______________________________________________________

Been served an eviction notice or been asked to vacate a property you were renting? q Yes q No

Willfully or intentionally refused to pay rent when due? q Yes q No If yes, when?____________________________________

Been sued for unlawful detainer? q Yes q No

How were you referred to us? q Newspaper (name) ________________ q Realtor (name) ____________ q Other ______________

Rental Unit applied for__________________________________________________________________________________________

Commencement date ________________________ Term _____________________ Rent/Month _______________________

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 ACKNOWLEDGEMENT

I/We, the undersigned, understand that __________________________________ is the leasing agent and representative for the owner/land-
lord and that the leasing agent’s fees will be paid by the owner/landlord. The undersigned acknowledge that this written notice was received prior
to the undersigned receiving a lease agreement.

________________________________________________ ______________________________________________
Applicant’s Signature Date Co-Applicant’s Signature Date

CONSENT TO OBTAIN CREDIT / EMPLOYMENT INFORMATION

I/We authorize __________________________________, to investigate my/our credit qualifications and hereby release, in any manner,
all of the information obtained by you. I/We further release all persons, agencies, or firms from any liabilities resulting from providing such
information.

I/We declare under penalty of perjury that the information listed in this application is true and correct.

Executed on this ________ day of _________________________, 20_____, in the city of __________________, state of __________.

________________________________________________ ____________________________________________
Applicant’s Signature Date Co-Applicant’s Signature Date

The undersigned authorizes landlord, leasing agent, and representatives of owner/landlord to contact the undersigned's current or previous
landlord, and current employer, and further, by a copy of this Application, authorizes any said landlord or employer to release pertinent residential
and employment history information to be used in evaluating my lease application. I further authorize owner/landlord, leasing agent or its
representatives to apply for or obtain an investigation or credit report in connection with this application. I understand that said investigation
or credit report may contain information obtained from various state governmental and private entities relative to the undersigned's number of
children, employment, occupation, general health, financial, and criminal history information.

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 FOR OFFICE USE ONLY – DO NOT WRITE BELOW

Application Verification Person Contacted Remarks

q Present Landlord
q Previous Landlord
q Applicant’s Employment
q Co-Applicant’s Employment
q Bank
q Reference (1)
q Reference (2)
q Reference (3)
q Other
q Driver’s License/ID
q Credit Bureau

Verification completed by: _______________________________

MONIES RECEIVED
Date: ______________________________________________ Date Description Amount
Remarks: ___________________________________________ Application Fee
Security Deposit
__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________ THIS APPLICATION: q Is Approved q Is Not Approved

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