Rental/Credit Application 

Personal Information

Date:	     	Application Taken By:	     	
	
E-mail Address	     	 Phone No.	     	
				
Name of Applicant	     	Date of Birth	     	
	
	     			
	
Present Address	     	City 	     	
State	     	Zip	     	
	
Prior Address	     	City 	     	
State	     	Zip	     	
	
How long have you lived at present address?	     	How long have you lived at prior address?	     	
	
Name of Landlord	     	Telephone	     	
	
Prior Landlord	     	Telephone	     	
	
How many will be living in this unit?	Adults	     	Children	     	
	Pets	     	Weight of Pets	     	
	
Employer	     	Occupation	     	
Current Salary	     		
	
How Long?	     	Contact Person	     	
Telephone	     	

Spouse Information

Name of Spouse	     	Date of Birth	     	
Telephone:	     	
	
Social Security No.	      	Driver’s License No.	     	
	
Employer	     	Occupation	     	
Current Salary	     		
	
How Long?	     	Contact Person	     	
Telephone	     	

			     	
	     		     	
	
	     		
	     		

Personal References

Name/Relationship	Address	Telephone	
     		     		     	
	
     		     		     	
	
     		     		     	

		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?	     	
	
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?	     	
	
Been sued for unlawful detainer?		Yes		No 	
	
How were you referred to us?		Newspaper (name)	      	
	Realtor (Name)	     			Other	     	
Rental Unit Applied for	     	
	
Commencement Date	     	Term	     	Rent/Month	     	

Acknowledgement

I/We, 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 was received prior to the undersigned receiving a lease agreement.

Applicant’s Signature	Date 		Co-Applicant’s Signature	Date	

Consent to Obtain Employment Information

I/We authorize       to investigate my/our credit qualifications and hereby release, in any manner, all of the information obtained by you. I/We further release all persons, agencies, or firms from any liabilities resulting from providing such information.

I/We declare under penalty of perjury that the information listed in this application is true and correct.

Executed on this       day of      , 20     , in the city of      , state of      .

Applicant’s Signature	Date 		Co-Applicant’s Signature	Date