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 ……………………………..$_________

Last month’s rent (no Security deposit) …….$ _________

Credit check fee ………………………………$_________

Other (specify): ………………………………..$_________

TOTAL ………………………………………….$_________

APPLICANT

Full Name-include all names you use(d): __________________________________________________________________________

Home Phone: _______________________ Work Phone: _________________________ SSN: _____________________________

Driver's License Number/State: _____________________________ Other Identifying Information: __________________________

Vehicle Make: _______________ Model: ________________Color:___________ Year:_______ License Plate No./State: _________

ADDITIONAL OCCUPANTS (List everyone, including children, who will live with you):

Full Name: Relationship to Applicant:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

RENTAL HISTORY

Current Address: _____________________________________________________________________________________________

Dates Lived at Address: __________________________________________ Reason for Leaving: ___________________________

Landlord/Manager: ______________________________________________ Landlord/Manager's Phone: ______________________

Previous Address: ____________________________________________________________________________________________

Dates Lived at Address: __________________________________________ Reason for Leaving: ___________________________

Landlord/Manager: ______________________________________________ Landlord/Manager's Phone: ______________________

Previous Address: ____________________________________________________________________________________________

Dates Lived at Address: __________________________________________ Reason for Leaving: ___________________________

Landlord/Manager: ______________________________________________ Landlord/Manager's Phone: ______________________

EMPLOYMENT HISTORY

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: ______________________________

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INCOME

1. Your gross monthly employment income (before deductions): ………………………….. $___________________________

2. Average monthly amounts of other income (specify sources): ………………………...… $___________________________

_________________________________________________________________ $___________________________

_________________________________________________________________ $___________________________

TOTAL: ……….. $___________________________

CREDIT AND FINANCIAL INFORMATION

Bank/Financial Accounts Account Number Bank/Institution Branch

Savings Account: ______________________________________ ______________________________ ________________________

Checking Account: _____________________________________ ______________________________ ________________________

Money Market or Similar Account: ________________________ ______________________________ ________________________

Type of Account Account Name of Amount Monthly

Credit Accounts & loans (Auto loan, Visa, etc.) Number Creditor Owed Payments

Major Credit Card:______________________________ _________________ __________________ ____________ _____________

Major Credit Card:______________________________ _________________ __________________ ____________ _____________

Loan (mortgage, car, ____________________________ _________________ __________________ ____________ _____________

student loan, etc.):_______________________________ _________________ __________________ ____________ _____________

Other Major Obligations: _________________________ _________________ __________________ ____________ _____________

:_____________________________________________ _________________ __________________ ____________ _____________

:_____________________________________________ _________________ __________________ ____________ _____________

Miscellaneous

There are no large pets allowed, and No Dogs, but 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 Been Sued? Yes No

Been Evicted? Yes No Been convicted of a crime? Yes No

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: _____________________________

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, when accessed for a legitimate business purpose related to my tenancy.

Date: _________________________ Applicant: ___________________________________________________________________

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