APPLICATION TO RENT FORM Courtesy of

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Each Individual Occupant Who is Responsible for Rent Payment Landlord.com

MUST Complete A Separate Application Form (California Residents 18 years or older Apply)
PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE NAME SOCIAL SECURITY NUMBER

DATE OF BIRTH DRIVER'S LICENSE NO. STATE EMAIL ADDRESS HOME PHONE NUMBER
( )
1 PRESENT HOME ADDRESS CITY STATE ZIP CODE

LENGTH OF TIME STATE REASON FOR MOVING LANDLORD NAME LANDLORD PHONE NO.
( )
2 PREVIOUS HOME ADDRESS CITY STATE ZIP CODE

LENGTH OF TIME STATE REASON FOR MOVING LANDLORD NAME LANDLORD PHONE NO.
( )
3 NEXT PREVIOUS HOME ADDRESS CITY STATE ZIP CODE

LENGTH OF TIME STATE REASON FOR MOVING LANDLORD NAME LANDLORD PHONE NO.
( )

PROPOSED OCCUPANT(S)
DESCRIBE EACH & EVERY PERSON WHO WILL OCCUPY THE PREMISES

WILL YOU HAVE ANY PETS? IF YES, PLEASE DESCRIBE WILL YOU HAVE ANY LIQUID FILLED FURNITURE? IF YES, DESCRIBE

EMPLOYMENT/FINANCIAL INFORMATION
Present Employer
Occupation Name

How long with Phone Employer

this Employer number ( ) address

Name of your
Supervisor

Prior Employer
Occupation Name

How long with Phone Employer

this Employer number ( ) address

Name of your
Supervisor

Current Gross Income Year Name of your Bank Branch or Address Account Number
Week Checking
$ PER
Month Savings

Please List ALL of your Financial Obligations (If More Creditors Use Additional Sheet of Paper)

Name of Creditor Address Phone Number Monthly Payment Amt.

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COPYRIGHT 1999-2004 WWW.LANDLORD.COM (APPRENT2.PDF )

 EMERGENCY/PERSONAL REFERENCE INFORMATION
IN CASE OF EMERGENCY, NOTIFY: ADDRESS PHONE RELATIONSHIP
1.

2.

MOTHER'S MAIDEN NAME:

PERSONAL REFERENCES ADDRESS PHONE YEARS KNOWN

1.

2.

3.

VEHICLE INFORMATION- (Please state exact number of motor vehicle that will be at the premises)

VEHICLE MAKE MODEL YEAR LICENSE NO.

VEHICLE MAKE MODEL YEAR LICENSE NO.

MOTORCYCLES (OTHER VEHICLES) MODEL YEAR LICENSE NO.

Have you ever filed for bankruptcy? IF YES, DATE BK FILED AND DESCRIBE:

Have you ever been evicted or asked to move? IF YES, PLEASE DESCRIBE:

APPLICANT AUTHORIZATION

Applicant represents that all the above statements are true and correct and hereby authorizes landlord/agent to verify the above items including, but not limited
to, the obtaining of a credit report and agrees to furnish additional credit references upon request. Landlord/Agent received a payment of $
which will be used to verify Applicant's credit history and other background information. The amount charged is itemized as follows:
1. Actual cost of credit report, including any eviction search, and/or other verifying reports: $
2. Landlord/Agent cost to process and screen applicant's supplied information: $
3. TOTAL FEE charged (not to exceed $30.00 per applicant (California Residents Only)): $
The undersigned makes application to rent housing accommodations designated as:
Address of: Apt. No. City/State
the rental for which is $ per Month Week Other and upon approval of this application agrees to sign a rental or lease
agreement and to pay all sums due, including required deposits, before occupancy.

Date Signature of Applicant

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