Rental Application

Rental #:

Please Tell Us about Yourself

Last Name: First Name:
Middle: Maiden:
Date of Birth: Marital Status:

Minor Occupants
Name: Age: Relationship:
Name: Age: Relationship:
Name: Age: Relationship:

Pets
Type: Breed: Age: Weight: Tank/Cage:
Type: Breed: Age: Weight: Tank/Cage:
*Please indicate ANY and ALL types of pets (fish, birds, reptiles, etc.) including size of tanks/cages

Contact Information
Home Phone No.: Cell Phone:
Work Phone: *Email:
Present Address:
City: State: Zip:
Own / Rent: Own Rent Since:

Landlord / Mtg. Co.
Name: Phone No.:
Address:
City: State: Zip:

Previous Address:
City: State: Zip:
Own / Rent: Own Rent Since:

Please Tell Us about Your Job

Present Employer: Address:
City: State: Phone:
Position: Start Date:
Monthly Income: End Date:
Description:

Previous Employer: Address:
City: State: Phone:
Position: Start Date:
Monthly Income: End Date:
Description:

Please Give Us the Following Information

Emergency Contact: Address:
City: State: Phone:

Automobiles
Year: Make: Model: Color: Tag #:
Year: Make: Model: Color: Tag #:

Bank Reference: Location:

Have you ever had an eviction filed against you?
Have you or any occupants ever been arrested for, convicted of, put on probation for, or had adjudication withheld or deferred for a felony offense?
Have you filed for bankruptcy in the past seven years? (Discharged? )
If you answered yes to any of the above questions, please explain:

*This application MUST be returned with the following:
• A copy of your driver's license, or state identification card (if no driver's license)
• Your social security number or a copy of your social security card
• A copy of income verification (paystub, direct deposit form, most recent tax forms, new hire letter of intent)
• A copy of the County license and shot records (for any pets)
• A cashier's check, money order, company, or personal check for $50.00 for EACH application (non-refundable)
*A separate application is to be completed for EACH person 18 years of age or older

Applicant has/will paid/pay a "reservation fee" of $____________ (equal to one month's rent, if left blank)in consideration of taking the dwelling unit off the market while considering approval of this application. If applicant is approved, and the contemplated lease is entered into, then on the day of move in the fee will be credited toward payment of the move-in costs. If applicant is approved but fails to enter into the contemplated lease, or fails to move in on the agreed upon date, the "reservation fee" will be retained by the owner as liquidated damages. The reservation fee will only be refunded to the applicant if the applicant is not approved for residency through this agency. Refunds will be sent via mail within 30 days of cancellation. By signing below, you are stating that you have read and agree to the provisions as stated.

Applicant represents that all of the above information and statements on the application for residence are true and complete, and hereby authorize an investigative consumer report including, but not limited to, residential history (rental or mortgage), employment history, criminal history, court records, and credit reports. This application must be signed before it can be processed by management. Applicant acknowledges that false or omitted information herein may constitute grounds for rejection of this application, termination of right to occupancy, and/or forfeiture of fees or deposits and may constitute a criminal offense under the laws of this state.

By electronically signing below, you are stating that you have read and agree to the provisions as stated.

*Applicant Signature: *Date: