Rental Application

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Today’s Date

Property address

Applicant Name (First / Middle / Last)

Applicant Email

Daytime Telephone

Work Telephone

Marital Status(required)

Single

Married

Divorced

Driver’s License Number

Driver’s License State of Issue

Date of Birth

Social Security Number

Present Address

Present Monthly Rent

How Long Have you Lived at Your Present Address?

Present Landlord’s Name

Present Landlord’s Telephone Number

Employed By:

Co-Applicant Name

Co-Applicant Date of Birth

Co-Applicant Social Security Number

Co-Applicant Driver’s License Number

Below, select the box to indicate an “Yes” answer

Are you current with your present rent? Have you ever filed for bankruptcy? Have you ever broken a rental or lease agreement? Do you smoke or use tobacco? Do you pay monthly rent on time? Have you ever been evicted? Have you been convicted of a felony? Do you have pets? Are there any pending criminal and/or civil charges against you?

If you answered yes to above questions, please explain in the space below.

How many people will reside at this property?

How many autos will you keep at this address?

Are you or your spouse currently military service of any governmental agency or branch subject to the provisions o the Service Member Civil Relief Act?(required)

Yes

By clicking “submit application” below, applicant(s) represents to the Lessor that the information listed above is true and correct, and that the same is given for the purpose of securing a lease agreement on said property. Applicant(s) hereby authorizes verification of all information contained herein and gives approval for a background check for the purpose of this rental application. False information given above shall be grounds for lessor’s rejection of this application, non-return of deposit(s), and termination of right to occupancy and it may constitute a criminal offense. Applicant agrees and provides this information with the understanding that the lessor may at his or her option report said information to established reporting agencies. Applicant hereby releases lessor from any liability therefrom.

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