Rental Application Form
Personal Information
Name SS# Date of Birth
Email Address
Current Address City State Zip
How Long: From/To Amount of Rent Paid per
Current Home # Cell # Pager # Work #
Reason for Leaving
Current Landlord Phone#
1. Previous Landlord Phone#
Address
2. Previous Landlord Phone#
Address
Current Employer Your Position
Phone# Address
Gross Weekly Income Supervisor How Long?
Previous Employer Your Position
Phone# Address
Supervisor How Long?
Person to Contact in Case of Emergency
Address
Relationship Phone#
Have you ever been evicted? Have you ever filed bankruptcy? Have you ever been convicted of a felony?
If yes to any of the above, please explain
Any other source of income? If yes, please explain
Number of cars Make Model License #
Credit References
Bank Address
Phone#
Checking # Savings #
Other
Character References
1.
2.
3.

 

How did you hear about us?

I certify that the information provided is true, accurate and complete. I understand that if any such information I provided is not as represented, then I may, at the owner’s sole discretion, be disqualified as a tenant. I authorize the verification of this information, and any and all inquiries necessary to verify the information provided herein, including, but no limited to, direct contact of any or all employers, past employers, landlord, past landlords, credit bureaus, neighbors, police agencies, individuals and financial institutions listed above and any and all other sources of information which the owner may deem necessary and appropriate within its sole discretion. I understand that this is not a lease or an offer to rent. No binding obligation of any kind exists between the owner and myself unless and until a lease is signed. This Application is subject to prior Applications. This Application shall remain the property of the owner.

Owner is not liable to the applicant, applicant’s heirs, executors, administrators or assigns for any damage of any kind, actual or consequential, by reason of the verification by the owner of the information provided by the applicant, and applicant hereby releases all actions, causes of action of any kind or nature that may arise by virtue of the execution or implementation of the application verification provided herein.

No person shall be denied the right to rent our property because of their race, color, religion, sex, national origin or ancestry.

Electronic Signature (your initials) Date

 

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If you do not wish to submit your application at this time, you can and FAX it to: (513) 751-0400