Rental/Credit Application 

Personal Information

Date:	     	Application Taken By:	     	
	
E-mail Address	     	 Phone No.	     	
				
Name of Applicant	     	Date of Birth	     	
	
Social Security No.	     	Driver’s License No.	     	
	
Present Address	     	City 	     	
State	     	Zip	     	
	
Prior Address	     	City 	     	
State	     	Zip	     	
	
How long have you lived at present address?	     	How long have you lived at prior address?	     	
	
Name of Landlord	     	Telephone	     	
	
Prior Landlord	     	Telephone	     	
	
How many will be living in this unit?	Adults	     	Children	     	
	Pets	     	Weight of Pets	     	
	
Employer	     	Occupation	     	
Current Salary	     		
	
How Long?	     	Contact Person	     	
Telephone	     	

Spouse Information

Name of Spouse	     	Date of Birth	     	
Telephone:	     	
	
Social Security No.	      	Driver’s License No.	     	
	
Employer	     	Occupation	     	
Current Salary	     		
	
How Long?	     	Contact Person	     	
Telephone	     	
Bank Information

Bank Name	     	Branch	     	
Telephone	     	Address	     	
	
Checking Account No.	     		
Savings Account No.	     		

Personal/Credit References

Name	Relationship	Telephone	
     		     		     	
	
     		     		     	
	
     		     		     	

Credit Grantor	Address	Telephone	
     		     		     	
	
     		     		     	
	
     		     		     	

Other Information

Number of Vehicles (Including company cars)	     	
	
Make/Model	     	Year	     	
Color:	     	Tag No.	     	State	     	
	
Make/Model	     	Year	     	
Color:	     	Tag No.	     	State	     	
	
Make/Model	     	Year	     	
Color:	     	Tag No.	     	State	     	
	
HAVE YOU EVER	
Filed for Bankruptcy		Yes		No  If yes, when?	     	
	
Been served an eviction notice or been asked to vacate a property you were renting?		Yes		No	

Willfully or intentionally refused to pay rent when due?		Yes		No 	
If yes, when?	     	

Been sued for unlawful detainer?		Yes		No 	
	
How were you referred to us?		Newspaper (name)	      	
	Realtor (Name)	     			Other	     	
Rental Unit Applied for	     	
	
Commencement Date	     	Term	     	Rent/Month	     	

Acknowledgement

I/We, the undersigned, understand that       is the leasing agent and representative for the owner/landlord and that the leasing agent’s fees will be paid by the owner/landlord. The undersigned acknowledge that this written notice was received prior to the undersigned receiving a lease agreement.

Applicant’s Signature	Date 		Co-Applicant’s Signature	Date	

Consent to Obtain Credit/Employment Information

I/We authorize       to investigate my/our credit qualifications and hereby release, in any manner, all of the information obtained by you. I/We further release all persons, agencies, or firms from any liabilities resulting from providing such information.

I/We declare under penalty of perjury that the information listed in this application is true and correct.

Executed on this       day of      , 20     , in the city of      , state of      .

Applicant’s Signature	Date 		Co-Applicant’s Signature	Date	

The undersigned authorizes landlord, leasing agent, and representatives of owner/landlord to contact the undersigned's current or previous landlord, and current employer, and further, by a copy of this Application, authorizes any said landlord or employer to release pertinent residential and employment history information to be used in evaluating my lease application. I further authorize owner/landlord, leasing agent or its representatives to apply for or obtain an investigation or credit report in connection with this application. I understand that said investigation or credit report may contain information obtained from various state governmental and private entities relative to the undersigned's number of children, employment, occupation, general health, financial, and criminal history information.

For Office Use Only – Do Not Write Below

Application	Person Contacted	Remarks	
						
	Present Landlord		     		     	
		
	Previous Landlord		     		     	
	
	Applicant’s Employment		     		     	
	
	Co-Applicant’s Employment	     		     	
						
	Bank		     		     	
	
	Reference (1)		     		     	
	
	Reference (2)		     		     	
	
	Reference (3)		     		     	
	
	Other		     		     	
	
	Driver’s License/ID		     		     	
	
	Credit Bureau		     		     	

Verification completed by:	     	
	
Date:	     	
	
Remarks:	     	

Monies Received

Date	Description	Amount	
     	Application Fee	     	
     	Security Deposit	     	
     	     	     	

THIS APPLICATION:		Is Approved		Is Not Approved