APPLICATION FOR LEASE &
AUTHORIZATION FOR CREDIT/BACKGROUND CHECK
1 LEASE TERMS (If Available)
2 Premises Address
3 Monthly Rental $ Security Deposit $
4 Lease Term From To
5 APPLICANT
6 Name Contact Phone
7 Submit separate applications for each co-applicant. Indicate here the number of additional applications, if any:
8 Present Address
9 E-Mail Address
10 Social Security # Date of Birth
11 Number to Occupy Premises: Adults Children Under 18 Pets
12 Type & Weight of Each Pet
13 Nearest Relative (other than any co-applicant) Relation
14 Address Phone
15 Current Landlord Phone
16 Address
17 Current Rent $ Lease Expires
18 # of Years at Current Address Sharing Premises? (check one) Yes No How Long?
19 Reason for Moving
20 Previous Address How Long?
21 Previous Landlord Phone
22 Address
23 Do You Smoke? (check one) Yes No
24 EMPLOYMENT
25 Employer Years
26 Address
27 Position Gross Annual Income $
28 Supervisor's Name Phone
29 Previous Employer (if current employment is under 2 years)
30 Address Years
31 Position Gross Annual Income $
32 Supervisor's Name Phone
33 Applicant Initials:
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34 OTHER INCOME
35 Source Amount $ Frequency
36 Source Amount $ Frequency
37 FINANCIAL OBLIGATIONS (debt payments, credit cards, judgments, alimony, child support, etc)
38 Description Amount $ Frequency
39 Description Amount $ Frequency
40 Description Amount $ Frequency
41 Description Amount $ Frequency
42 BANK ACCOUNTS
43 Bank Checking Savings
44 Bank Checking Savings
45 Bank Checking Savings
46 VEHICLES
47 Make/Model Year License Plate # State
48 Make/Model Year License Plate # State
49 Make/Model Year License Plate # State
50 Yes No (check one) Have you ever been asked to leave or been denied the renewal of a lease? If yes, give details:
51
52
53 Yes No (check one) Any litigation, prior or pending, such as evictions, suits, judgments, bankruptcies, foreclosures,
54 criminal proceedings, etc? If yes, give details:_________________________________________________________
55
56 Yes No (check one) Are you or any intended occupants a sex offender, sexual predator or otherwise subject to
57 reporting requirements of the Illinois Sexual Offender Registration Act or any similar law in any other jurisdiction?
58 $ has been paid for this credit/background check. THIS SUM IS NOT REFUNDABLE.
59 I authorize a credit check, investigation and criminal background check to be made whereby information is obtained
60 about my credit history and by interviews with landlords and/or others with whom I am acquainted. This inquiry may
61 include information as to my character, and general reputation. I expressly authorize the results of the credit check and
62 criminal background check to be provided to the Landlord. I understand I have a right to make a written request within a
63 reasonable period of time to receive additional, detailed information about the nature and scope of this investigation,
64 including copies of any reports obtained by the Landlord in connection with this application.
65 I certify that I have read the above application and that the information contained therein is true and correct. I understand
66 that this application shall be incorporated into and become a part of the lease for the Premises sought, and that any false
67 information provided by me shall be grounds for cancellation of the lease.
68 I expressly authorize this application, the credit report and related information to be provided to the Landlord, who may
69 use it to determine my suitability as a Tenant as permitted or required by law.
70
71 Signature of Applicant Date
72
73 Print Applicant's Name
74
75 Print Premises Address
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