"Rental/Credit Application Form"

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RENTAL/CREDIT APPLICATION
PERSONAL INFORMATION
Date___________Name___________________________Telephone:________________
Date of Birth________________________Email:_______________________________
Social Security No.________________________Driver’s License No.______________
Present Address__________________________________________________________
City___________________________State________________Zip Code_____________
Prior Address________________________City______________State_______Zip_____
How long have you lived at your present address?_At your prior address?________
What is your current rent?
Do you smoke?
Name of Landlord_______________________Telephone_________________________
Prior Landlord__________________________Telephone_________________________
How many in your family? Adults____Children______Pets# and Kind_______________
Employer___________________________Telephone____________________________
Position_______________________How Long?__________Monthly Income_________
PARTNER OR SPOUSE INFORMATION
(For roommates use another front page)
Date___________Name___________________________Telephone:________________
Date of Birth________________________Email:_______________________________
Social Security No.________________________Driver’s License No.______________
Present Address__________________________________________________________
City___________________________State________________Zip Code_____________
Prior Address________________________City______________State_______Zip_____
How long have you lived at your present address?_At your prior address?________
What is your current rent?
Do you smoke?
Name of Landlord_______________________Telephone_________________________
Prior Landlord__________________________Telephone_________________________
How many in your family? Adults____Children______Pets# and Kind_______________
Employer___________________________Telephone____________________________
RENTAL/CREDIT APPLICATION
PERSONAL INFORMATION
Date___________Name___________________________Telephone:________________
Date of Birth________________________Email:_______________________________
Social Security No.________________________Driver’s License No.______________
Present Address__________________________________________________________
City___________________________State________________Zip Code_____________
Prior Address________________________City______________State_______Zip_____
How long have you lived at your present address?_At your prior address?________
What is your current rent?
Do you smoke?
Name of Landlord_______________________Telephone_________________________
Prior Landlord__________________________Telephone_________________________
How many in your family? Adults____Children______Pets# and Kind_______________
Employer___________________________Telephone____________________________
Position_______________________How Long?__________Monthly Income_________
PARTNER OR SPOUSE INFORMATION
(For roommates use another front page)
Date___________Name___________________________Telephone:________________
Date of Birth________________________Email:_______________________________
Social Security No.________________________Driver’s License No.______________
Present Address__________________________________________________________
City___________________________State________________Zip Code_____________
Prior Address________________________City______________State_______Zip_____
How long have you lived at your present address?_At your prior address?________
What is your current rent?
Do you smoke?
Name of Landlord_______________________Telephone_________________________
Prior Landlord__________________________Telephone_________________________
How many in your family? Adults____Children______Pets# and Kind_______________
Employer___________________________Telephone____________________________
Position_______________________How Long?__________Monthly Income_________
EMERGENCY CONTACT INFORMATION
(at least one Family member)
Name__________________________
Telephone__________________________
Address
Name
Telephone
Address
PERSONAL REFERENCES
Name
Relationship
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? ______________________________
Have you ever:
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?_____
Have you ever been convicted of a crime? ___Yes ___No If Yes, please give
details____________________________________________
Are you a registered sex offender? ___Yes ___No
How were you referred to us?
Newspaper (name)___________________Realtor__________________Other_________
Rental unit applied for_____________________________________________________
Commencement date_______________________Term______________Rent/Month____
DISCLOSURE
I, 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 is received prior to the undersigned receiving a
lease agreement.
RADON GAS – Notice to Prospective Tenant: Radon is a naturally occurring radioactive gas
that, when it has accumulated in a building in sufficient quantities, may present health risks to
persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines
have been found in buildings in this state. Additional information regarding radon testing may be
obtained from your county public health unit.
I / We Declare the foregoing information is true and correct, and I/We hereby authorize you to
conduct an employment and credit check and to verify our references.
_______________________________________
________________________________
Applicant’s Signature
Co-Applicant’s Signature
Date
Date
FORMS - RENTAL-CREDIT APPLICATION FORM
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