About this Form: This sample rental application does not ask for the applicant's Social Security Number, nor does it ask for any bank account information. If you seek a form that asks the applicant for this information, click here.

RENTAL APPLICATION
Equal Housing Opportunity

The undersigned hereby makes an application to rent the following property: ____________________________________________________________________________________. 

Anticipated move date of ___________________at a monthly rent of $_______________ and security deposit of $_______________.

PLEASE TELL US ABOUT YOURSELF

Full Name__________________________________________________ Home Phone (        ) ________________________

Date of Birth_________________________________

Email Address:__________________________________________(optional)    Other Phone (       ) ___________________

Co-Applicant Name_________________________________________ Co-Applicant Date of Birth_____________________

Names of Dependents_______________________________________ Dependents Date of Birth _____________________

List All Pets__________________________________________________________________________________________

 

PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)

Current Address_______________________________Apt#________ City__________________ State______ Zip________

Month/Year Moved In______________________ Reasons for Leaving____________________________Rent $__________

Owner/Agent__________________________________________________Phone (       ) ____________________________

Previous Address (last 3 years)_________________________________________________________Rent $____________

Owner/Agent__________________________________________________Phone (       ) ____________________________

 

PLEASE DESCRIBE YOUR CREDIT HISTORY
Have you declared bankruptcy in the past seven (7) years?Yes___________ No____________
Have you ever been evicted from a rental residence?Yes___________ No____________
Have you had two or more late rental payments in the past year?Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due?Yes___________ No____________


PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION

Your Status:  _____Full Time _____Part Time _____Student _____Unemployed

Employer______________________________________________________________________________________________

Dates employed_______________________________ Employed as______________________________________________

Supervisor Name______________________________________________ Phone (        )______________________________

Salary $_________________per________________.  (If employed by above less than 12 months, give name & phone of previous employer or school:________________________________________________________________________________.)

If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.


Amount $___________________ Source/Contact Name__________________________________________________________

 

PLEASE LIST YOUR REFERENCES

Personal Reference or Emergency Contact:

Name _______________________ Address _______________________________________________

Phone _______________________ Relationship_______________________


Driver's License:

Your Driver's License Number_________________ State_________________


Vehicle Information:

Make / Model _________________Year _________________License Plate State_________________

 

ADDITIONAL INFORMATION:

Please give any additional information that might help owner/management evaluate this application?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Where may we reach you to discuss this application?

Day Phone # (         ) ___________________________ Night Phone # (          )____________________________

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.

I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted in 3 business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When so approved and accepted, I agree to execute a lease for ___________ months before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, and investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.


Please sign:  X__________________________________     __________________________________
                                   Name of Applicant                                                   Date

AUTHORIZATION
Release of Information

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner/manager.

_____________________________________________
Name (please print)

X_______________________________________       __________________________
Signature                                                                                 Date



APPLICANT:  PLEASE DO NOT WRITE BELOW  (FOR OFFICE USE ONLY)

Deposit of $__________________ Received by ____________________________ Date_______________

OFFICE NOTES: