rental_application

Do not use TESTING!

Last Name	First Name	Middle Name	Social Security Number

Date of Birth	Driver License Number	Driver License Expiration	State	Home Phone No.

Present Address
Street Address	City	State	Zip Code

Date In	Date Out	Owner/Manager Name	Owner/Manager Phone

Reason for Moving

Previous Address
Street Address	City	State	Zip Code

Date In	Date Out	Owner/Manager Name	Owner/Manager Phone

Reason for Moving

Next Previous Address
Street Address	City	State	Zip Code

Date In	Date Out	Owner/Manager Name	Owner/Manager Phone

Reason for Moving

Proposed Occupants - List all in addition to yourself
Name	Name	Name	Name


Will you have pets? Describe.

Will you have liquid filled furniture? Describe.

A. Present Occupation		Employer Name

How long with this employer?	Phone Number	Employer Address

Name of Supervisor		City	State	Zip Code

B. Previous Occupation		Employer Name

How long with this employer?	Phone Number	Employer Address

Name of Supervisor		City	State	Zip Code

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

Name of Creditor	Address	Phone Number	Monthly Amount
			$
			$
			$
			$
			$
			$
In case of emergency notify:
Name	Address	City	Phone Number	Relationship


Personal References
Name	Address	City	Phone Number	Relationship


Mother Maiden Name

Automobiles
Make	Model	Year	License Plates



Have you ever filled for bankruptcy?			If Yes, Year?
Have you ever been evicted or asked to move?			If Yes, Year?

Applicant represents that all of the above statements are true and correct and hereby authorizes verification of the above items including, but not limited to, the obtaining of a credit report and agrees to furnish additional credit references upon request.
			Deposit Amount	$
Owner received a payment of $, which is to be used to screen Applicant with regards to credit history and other background information. The amount charged is itemized as follows:
1. Actual cost of credit report, unlawful detainer (eviction) search, and/or other screening reports:				$
2. Cost to obtain, process and verify screening information (may include staff time and other soft costs)				$
3. Total fee charged (may not exceed $30 per applicant)				$
The undersigned makes application to rent housing accommodations designated as:
Apartment Number	Located at:
the rental for which is $ per 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:

Date:

Address you are applying for:

Deposit Amount: $

Rent Amount: $