RENTAL APPLICATION
A. Subject Premises
1. Location of Premises __________________________________________________
2. Rental Term to Commence: ____________________3. Term of Rental ___________
4. Monthly Rent _________________5. Security Deposit Amt. Received____________
6. Application Fee Amount Received_____$ 20________________________________
B. Applicant Information
7. Applicant Name______________________________________________________
8. Address_____________________________________________________________
9. Telephone Home____________________ Work____________________________
10. Birthdate______________________Birthplace______________________________
11. I.D. (Driver’s License or Social Security No.)________________________________
C. Applicant’s Household
12. List All Household Member Who Will Live in Rented Premises
Name Age Occupation/School
A. _____________________ _______ ________________________
B. _____________________ _______ ________________________
C. _____________________ _______ ________________________
D. _____________________ _______ ________________________
D. Applicant’s Rental History
13. Length of Time at Current Address (in item B)_______________________________
14. Name of Present Landlord________________________________________ Telephone _____________
15. Previous Address ______________________________________________________
16. Length of Time and Previous Address______________________________________
17. Previous Landlord_______________________________ Telephone _____________
E. Applicant’s Employment/Financial Background
Length of Time
18. Current Occupation_____________________________ in Position_______________
19. Employer’s Name/Address_______________________________________________
20. Employer Contact Name/Telephone________________________________________
21. Current Salary_______________________________________
22. Educational Background (if applicable)_____________________________________
23. Spouse’s Occupation____________________________ Length of Time in Current Position_________________
24. Spouse’s Employer/Address/Telephone__________________________________
25. Spouse’s Salary____________________________
26. Name of Your Bank_________________________________________________
27. Bank Address______________________________________________________
28. Checking Acct. No_________________________ Savings Acct. No___________
29. Other Sources of Income_____________________________________________
30. Other Resources____________________________________________________
F.. Applicant’s Vehicles
31. Number of Vehicles to be Parked at Rented Premises_________
32. Description of All Vehicles:
Make/Model Year Color State License Plate
A. ______________ ________ _________ ________ ____________
B. ______________ ________ _________ ________ ____________
C. ______________ ________ _________ ________ ____________
G. Miscellaneous
33. Have you ever:
A. been evicted? Yes No
B. failed to timely pay rent? Yes No
C. filed for bankruptcy? Yes No
Please explain below if you checked “yes” for any items.
H. Pets
34. List any pets that live with you including service animals:
Type Animal Age Size/weight
__________________________________________________________________
___________________________________________________________________
DISCLOSURE/AGREEMENT/CONSENT
1. I/We understand that__N/A____________ is an agent of the Landlord and is a paid representative of the Landlord.
I/We acknowledge that this written notice was received before I/we received a lease agreement.
2. I/We authorize you to conduct an employment/credit check concerning my/our application and to verify all references.
3. I/We declared that all information listed on this application is true and accurate.
____________________________________
Applicant’s Signature & Date
____________________________________
Co-Applicant’s Signature & Date
____________________________________
Application Received By & Date
Phyllis Johnson, Owner/ Landlord
Office: 540 / 254-3410
Fax: 540 / 254-3411
