RENTAL APPLICATION

APPLICANT

NAME First: Middle: Last:

PHONE NUMBERS
Home:
Work:
Cell:

SOCIAL SECURITY NUMBER #

BIRTH DATE Month: - Month - January Febuary March April May June July August September October November December Day: Year:

DRIVERS LICENSE # State: #

AUTOMOBILE Year: Make: Model:

LICENSE PLATE # & State:

EMERGENCY CONTACT Name:
Tel #

RESIDENTIAL HISTORY LAST TWO YEARS

PRESENT ADDRESS.  Apt:

CITY.STATE.ZIP City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

OCCUPANCY DATES In: Out:

MONTHLY RENT: $

OWNER/LANDLORD/NAME: PHONE #

REASON FOR MOVING:

PREVIOUS ADDRESS: Apt:

CITY.STATE.ZIP City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

OCCUPANCY DATES In: Out:

MONTHLY RENT: $

OWNER/LANDLORD/NAME: PHONE #

REASON FOR MOVING:

CURRENT EMPLOYMENT PLEASE ATTACH PAY STUBS

EMPLOYERS NAME:

ADDRESS:

CONTACT PERSON:  PHONE #:

YOU’RE POSITION:

HIRE DATE Month: - Month - January Febuary March April May June July August September October November December Day: Year:
MONTHLY GROSS SALARY: $

OTHER OCCUPANTS THAT WILL LIVE IN HOME NAMES,
AGE & RELATIONSHIP:

DO YOU HAVE PETS? Yes No
IF YES DESCRIBE:




HAVE YOU EVER BEEN CONVICTED OF ANYTHING OTHER
THAN A TRAFFIC VIOLATION? Yes No

IF YES EXPLAIN:




HAVE YOU EVER BEEN CONVICTED IN THE SALE OR
MANUFACTURING OF ILLEGAL DRUGS? Yes No

IF YES EXPLAIN:




MAY WE DO A HOUSEKEEPING CHECK ON YOUR PRESENT
RESIDENCY IF NEEDED? Yes No




DO YOU OWN WATERBEDS? Yes No
HAVE YOU EVER BEEN EVICTED? Yes No




HAVE YOU EVER FILED BANKRUPTCY? Yes No
IF YES WHEN:
DISCHARGED: Yes No


CHECKING ACCOUNT: #
BANK NAME:




ARE YOU A MEMBER OF THE ARMED FORCES? Yes No
IF YES, ARE YOU: ACTIVE OR RESERVE Active Reserve




I (UNDERSIGNED) DO HEREBY GIVE PERMISSION TO HAVE ANY
INFORMATION VERIFIED INCLUDING CREDIT, EMPLOYMENT, INCOME,
BANK ACCOUNT, RENTAL HISTORY, AND CRIMINAL BACKGROUND
INFORMATION. I FURTHER AGREE THAT A PHOTOCOPY OF THIS
AUTHORIZATION MAY BE ACCEPTED.

PROOF OF IDENTIFICATION AND A SOCIAL SECURITY CARD IS REQUIRED.

INITIAL FUNDS MUST BE CERTIFIED IN A MONEY ORDER OR CASHIERS CHECK.

EL PRIMER PAGO TIENE QUE SER UN ORDEN DE PAGO O CHEQUE DEL BANKO.

APPLICANT SIGNATURE     DATE
                                                                    (Type Name)