Residential Rental Application 

Name of Applicant: ___________________________________________________________

Previous Name (s): (maiden) ___________________________________________________

Current Address: _____________________________________ How Long? ______________

City: _________________________ State:_____ Zip:________ Phone No:_______________

Date of Birth: ________ Drivers License No: ___________________ SSN: _______________

Landlord Name: ___________________________________ Phone No:__________________

Reason for Moving: ___________________________________________________________

Previous Landlord Name: ____________________________ Phone No: _________________

Previous Address: __________________________________________ How Long? ________

Reason for Moving: ___________________________________________________________

Names and Ages of All Proposed Occupants: _______________________________________

____________________________________________________________________________

List Automobiles of All Occupants:

Make & Model                                             Year           Color           License                              

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Water Bed? _____   Appliances? _________________________________________________

Pets? What kind? _____________________________________________________________

Have you ever been evicted? _____ If yes, please explain:

____________________________________________________________________________

____________________________________________________________________________

EMPLOYMENT INFORMATION

Present Employer: _____________________________________ Phone No: ______________

Address: ______________________________ City:______________ State:___ Zip:________

How Long? _____________ Supervisor: ___________________________________________

Job Description: ________________________________ Gross Monthly Income: ___________

Previous Employer: ____________________________________ Phone No: ______________

Address: _______________________________ City:_____________ State:___ Zip:________

How Long? _____________ Supervisor: ___________________________________________

Job Description: ________________________________ Gross Monthly Income: ___________

Other Income: _______________________ Source: __________________________________

Complete the other side in full and sign

CREDIT INFORMATION

Have you filed for bankruptcy in the past seven years? ________ If yes, please explain:

____________________________________________________________________________

Name of Bank: _______________________ Type of Account:_________ No.:_____________

City:_____________________ State:______ Phone:_________________

Name of Bank: _______________________ Type of Account:_________ No.:_____________

City:_____________________ State:______ Phone:_________________

Credit Cards and Other Creditors:

_____________________ Acct. No.________________ Pmt: $ ________ Bal: $ ___________

_____________________ Acct. No.________________ Pmt: $ ________ Bal: $ ___________

_____________________ Acct. No.________________ Pmt: $ ________ Bal: $ ___________

_____________________ Acct. No.________________ Pmt: $ ________ Bal: $ ___________ 

In case of emergency, please notify: ______________________________________________

Address: __________________ Phone: ______________ Relationship __________________

In case of emergency, please notify: ______________________________________________

Address: __________________ Phone: ______________ Relationship __________________

In case of emergency, please notify: ______________________________________________

Address: __________________ Phone: ______________ Relationship __________________

Applicant for tenancy represents that all the above statements are true, correct and complete and hereby authorizes verification of the information provided here including, but not limited to obtaining a credit report and verification of employment, and agrees to furnish additional credit information upon request. The cost of this credit processing is $_________ to be paid by the applicant. This cost is not rent or deposit and will not be refunded or applied to future rent in the event this application is denied.

Applicant's Signature: __________________________________________ Date:____________

A completed and signed application is required for each adult applicant.

EQUAL HOUSING OPPORTUNITY