RENTAL/CREDIT APPLICATION

Date: ____________________________________________

Interviewed by: _____________________________________

Personal Information

Name of Applicant ________________________________________________________________

Telephone _______________________________________________________________________

Social Security No. ________________________________________________________________

Driver’s License No. _______________________________________________________________

Present Address ____________________________________________________________________

City/State/Zip _____________________________________________________________________

Prior Address ______________________________________________________________________

City/State/Zip ______________________________________________________________________

How long have you lived at present address? ______________________________________________

Name of Present Landlord _____________________________________________________________

Present Landlord Telephone No. _________________________________________________________

How long have you lived at prior address? _________________________________________________

Name of Prior Landlord _________________________________________________________________

Prior Landlord Telephone No. _____________________________________________________________

How many people will be living in this unit?

Adults __________________

Children ________________

Pets ____________________

Type of Pet ___________________________________

Weight of Pets _________________________________

Pets Name(s) __________________________________

__________________________________

Employer _____________________________________________________________________________

Position ______________________________________________________________________________

How long? ____________________________________________________________________________

Telephone No. of Employer ______________________________________________________________

Spouse Information

Name ________________________________________________________________________________

Telephone ____________________________________________________________________________

Social Security No. _____________________________________________________________________

Driver’s License No. ____________________________________________________________________

Employer _____________________________________________________________________________

Position ______________________________________________________________________________

How long? ____________________________________________________________________________

Telephone No. of Employer ____________________________________________________________

Bank Information

Bank Name __________________________________________________________________________

Bank Telephone No. ___________________________________________________________________

Bank Address _________________________________________________________________________

Checking Account No. __________________________________________________________________

Savings Account No. ___________________________________________________________________

Personal References

Name Relationship Telephone No.

1. __________________________________________________________________________________

2. __________________________________________________________________________________

3. __________________________________________________________________________________

Other Information

Number of Vehicles (including company cars) ________________________

Car #1

Make/Model ___________________________________________________________________________

Year _________________________________

Color _________________________________

Tag No. _______________________________

State __________________________________

Car #2

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

Have you ever willfully or intentionally refused to pay rent when due? Yes No

If yes, when? _____________________________________

How were you referred to us? ______________________________________________________________

Rental Unit Address you are applying for ___________________________________________________

Start Date _________________________________________

Term _____________________________________________

Rent/Month ________________________________________

Disclosures

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 building in this state. Additional information regarding radon and radon testing may be obtained from your county public health unit.

Lead Paint: Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The seller of any interest in residential real estate is required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspection in the seller’s possession and notify the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase.

Acknowledgment

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 Date

________________________________________

Co-Applicant’s Signature Date

FOR OFFICE USE ONLY – DO NOT WRITE BELOW

Application Verification	Person Contacted	Remarks
Present Landlord
Previous Landlord
Applicant’s Employment
Co-Applicant’s Employment
Bank
Reference (1)
Reference (2)
Reference (3)
Other
Driver’s License/ID
Credit Bureau

Verification Completed By _______________________________________________________________

Date _________________________________________________

Remarks _______________________________________________________________________________

This application Approved Denied

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