RENTAL/LEASE APPLICATION
Date of Application: ________________________________________________________________
Property Address: ___________________________________________ Unit No.: __________
City, State, Zip Code: ______________________________________________________________
Applicant
First Name _____________________ Middle Initial _______ Last Name ____________________
Date of Birth _______________________ Social Security Number __________________________
Phone Number ________________________ Email Address _______________________________
Driver’s License No. ________________________ Driver’s License State of Issue __________
Applicant
First Name _____________________ Middle Initial _______ Last Name ____________________
Date of Birth _______________________ Social Security Number __________________________
Phone Number ________________________ Email Address _______________________________
Driver’s License No. ________________________ Driver’s License State of Issue __________
Residence History
Provide at least __________ years of history.
Current Address _______________________________________________ Unit No. __________
City, State, Zip Code ___________________________________________
Dates of Residence: From ______/______ To ______/______ Monthly Rent $___________
Reason For Moving ________________________________________________________
Check one: Own Rent Other (specify) _______________________________
If Rent, Name of Landlord ________________________ Landlord Phone No. ______________
Previous Address ______________________________________________ Unit No. __________
City, State, Zip Code ______________________________________
Dates of Residence: From ______/______ To ______/______ Monthly Rent $___________
Reason For Moving ________________________________________________________
Check one: Own Rent Other (specify) _______________________________
If Rent, Name of Landlord ________________________ Landlord Phone No. ______________
Have you ever been evicted? (Check one) Yes No
If yes, provide explanation ___________________________________________________
Have you ever broken a lease? (Check one) Yes No
If yes, provide explanation ___________________________________________________
Employment / Financial
Provide at least __________ years of history.
Current Employer ___________________________ Position/Title ___________________________
Address ___________________________________________________________________________
City, State, Zip Code ________________________________________________________________
Name of Supervisor __________________________ Phone Number ________________________
Dates of Employment: From ______/______ To ______/______
Monthly Income $___________
Previous Employer ___________________________ Position/Title __________________________
Address ___________________________________________________________________________
City, State, Zip Code ________________________________________________________________
Name of Supervisor __________________________ Phone Number ________________________
Dates of Employment: From ______/______ To ______/______
Monthly Income $___________
Previous Employer ___________________________ Position/Title __________________________
Address ___________________________________________________________________________
City, State, Zip Code ________________________________________________________________
Name of Supervisor __________________________ Phone Number ________________________
Dates of Employment: From ______/______ To ______/______
Monthly Income $___________
Other Sources of Income
(Provide any other sources of income that you want the Landlord to consider.)
Source of Income ______________________________ Amount of Income $___________
Source of Income ______________________________ Amount of Income $___________
Source of Income ______________________________ Amount of Income $___________
Financial Accounts
(Examples include Savings Account, Checking Account, Credit Account)
Name __________________________________ Account Type ______________________________
Account Number ____________________________________________________________________
Name __________________________________ Account Type ______________________________
Account Number ____________________________________________________________________
Name __________________________________ Account Type ______________________________
Account Number ____________________________________________________________________
Name __________________________________ Account Type ______________________________
Account Number ____________________________________________________________________
Name __________________________________ Account Type ______________________________
Account Number ____________________________________________________________________
List All Other Occupants at the Property
Name ________________________ Age __________ Relationship _____________________
Name ________________________ Age __________ Relationship _____________________
Name ________________________ Age __________ Relationship _____________________
Vehicles to be Parked at Property
Vehicle Make _____________________ Model ____________________ Year __________
Color ____________ License Plate Number __________________________State __________
Vehicle Make _____________________ Model ____________________ Year __________
Color ____________ License Plate Number __________________________State __________
Pets
Do you have any pets? (Check one) Yes No
If Yes, Type ________________ Breed ______________________ Weight ____________
Smoking
Do any of the occupants smoke? (Check one) Yes No
Other
Have you ever been convicted of a crime? (Check one) Yes No
If yes, provide explanation ___________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Have you ever declared bankruptcy? (Check one) Yes No
If yes, provide explanation ___________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Emergency Contact
First Name _____________________ Middle Initial _______ Last Name ____________________
Address ___________________________________________________________________________
City, State, Zip Code ________________________________________________________________
Relationship _________________________ Phone Number ________________________
Personal References
First Name _____________________ Middle Initial _______ Last Name ____________________
Address ___________________________________________________________________________
City, State, Zip Code ________________________________________________________________
Relationship _________________________ Phone Number ________________________
First Name _____________________ Middle Initial _______ Last Name ____________________
Address ___________________________________________________________________________
City, State, Zip Code ________________________________________________________________
Relationship _________________________ Phone Number ________________________
It is against the law to discriminate against any person in the terms, conditions or privileges
or rental of a dwelling, or in the provision of services or facilities in connection with such
dwelling, because of race, color, religion, sex, handicap, familial status or national origin.
State and local laws may protect additional classes from housing discrimination.
Applicant authorizes the verification of all statements and information provided in this
application including rental history, current and previous employment and income, bank and
credit account details and any other relevant information necessary for Landlord to evaluate
this application. If Applicant has provided any false or incomplete information in this
application, Landlord may reject this application and/or terminate the lease agreement.
Application Fee (Check one)
There is NO application fee.
Applicant will pay a non-refundable application fee in the amount of $___________ for
Landlord's review and verification of the statements and information contained in this
application.
Applicant certifies that all statements provided in this Lease Application are true, correct and
complete.
Applicant Signature _______________________________
Date ________________
Landlord Signature _______________________________
Date ________________
