Rental Application

Application to Tenancy

(319)-239-1387

Each Individual who is over 18 and occupying the unit MUST complete a separate application form.

I certify all information on application is true. If found otherwise I agree to immediate lease termination and eviction. ELECTRONIC SIGNATURE: *

Today's Date: *

Requested Move In Date: *

Address of House *

City of: *

Applicant's Full Name: *

Maiden Name or Alias (also known as): *

Date of Birth: *

Phone Number(s): Home *

Work: *

Driver's License Number: *

Social Security Number: *

Cell Phone: *

Email Address: *

Names and ages of children, dependents, or other occupants (leave extra boxes empty):

Occupant 1 *

Occupant 2 *

Occupant 3 *

Occupant 4 *

Occupant 5 *

Resident History

Please provide complete rental history for the past 3 years. Do not include relatives or friends.

Current Address (including name of complex and apartment number): *

City: *

State: *

Zip: *

Monthly Rent: *

Landlord/Agent's Name: *

Landlord/Agent's Address: *

Reason for Moving: *

Month and Year Moved In: *

Previous Address #1

Previous Address: *

City: *

State: *

Zip: *

Monthly Rent: *

Landlord/Agent's Name: *

Landlord/Agent's Address: *

Reason for Moving: *

Month and Year Moved In: *

Applicant Employment Information

Please Provide employment history for the past 3 years.

* Indicates required field

Current Gross Income (include ALL forms of income): *

Employment Status: *

Employed Unemployed

Current Employment: *

Current Employer name, address, and phone number: *

If unemployed, source of income: *

Other Employment Type (please explain): *

If a student, please name school, year in school, expected graduation date, area of study *

Job Title or Description: *

Employment Period: How Long *

From: *

To: *

Wage (per hr./weekly): *

Name, Address, and Phone Number of Supervisor: *

Previous Employer

Employer's Name and Phone Number: *

Job Title or Description: *

Employment Period: How Long *

From: *

To: *

Wage (per hr./weekly): *

Name and Phone Number of Supervisor *

Reason for Leaving *

Spouse's Employment Information

Please provide employment history for the past 3 years.

Employment Status: *

Employed Unemployed

Current Employment: *

If a student, please name school, year in school, expected graduation date, area of study *

Job Title or Description: *

If unemployed, source of income: *

Other Employment Type (please explain): *

Current Employer name, address, and phone number *

Employment Period: How Long *

From: *

To: *

Wage (per hr./week): *

Name and Phone Number of Supervisor *

Spouse's Previous Employer

Employer's Name and Phone Number *

Job Title or Description: *

Employment Period: How Long *

From: *

To: *

Wage (per hr./week): *

Name and Phone Number of Supervisor: *

Reason for Leaving: *

Financial Accounts and References

Name of Bank/Financial Institution: *

Checking Account: *

Yes No

Savings Account: *

Yes No

Other Income Sources

If there are other sources of income you would like us to consider, please list income, source, and person (banker, employer, or etc) who we could 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: *

Other Annual Income Amount ($): *

Source or Contact Name: *

References

Emergency Contact: *

Address *

City *

Home Phone: *

Work Phone: *

State: *

Cell Phone: *

Zip: *

Relationship: *

Personal References

Please provide three (3) personal references.

Reference #1

Name: *

Address: *

City: *

Home Phone: *

Work Phone: *

State: *

Cell Phone: *

Zip: *

Relationship: *

Reference #2

Name: *

Address: *

City: *

Home Phone: *

Work Phone: *

State: *

Cell Phone: *

Zip: *

Relationship: *

Auto & Driver Information

Your Driver License Number: *

State: *

Vehicle #1

Make: *

Year: *

Vehicle Insured? *

Yes No

Model: *

License Plate Number: *

If yes, what company: *

Vehicle #2

Make: *

Year: *

Vehicle Insured? *

Yes No

Model: *

License Plate Number: *

If yes, what company: *

Additional Questions

Please answer the following questions as they apply to you, to current household members, or anyone who will be living with you.

Have you ever. . .

1. BEEN OR ARE CURRENTLY BEING EVICTED OR RECEIVED A LEASE TERMINATION FROM A PROPERTY? *

Yes No

2. Provided Landlord with 30-day written notice? *

Yes No

3. Filed for Bankruptcy? *

Yes No

4. Been evicted from a tenancy or been in a foreclosure? *

Yes No

5. Willfully or intentionally refused to pay rent when due? *

Yes No

6. Been a Defendant in Forcible Entry and Detention FE&D (Eviction) action? *

Yes No

If yes, household member name: *

Court: *

Date: *

7. Ever been a Defendant in Money Judgement action for. . .

Unpaid rent/utilities? *

Yes No

Damages? *

Yes No

Noncompliance? *

Yes No

If yes, household member name: *

Court: *

Date: *

8. Any adverse credit conditions/situations in recent history that will show on your credit report? *

Yes No

If yes, please explain: *

9. Have you or any household member ever been. . .

A) Charged/convicted/pleaded "No Contest" to any Sex Offender charges? *

Yes No

B) Registered or required to register as a sex offender? *

Yes No

C) On any state's sex offender list? *

Yes No

If yes, household member's name: *

Violations: *

Date: *

Court: *

10. Been convicted on a charge involving illegal use, abuse, possession, manufacture, or distribution of a controlled substance? *

Yes No

If yes, household member's name: *

Violations: *

Date: *

Court: *

11. A current legal or illegal user of a controlled substance? *

Yes No

If yes, household member name: *

12. Been convicted of any crime (not including traffic violations)? *

Yes No

If yes, household member's name: *

13. Ever been convicted of a felony or aggravated misdemeanor? *

Yes No

If yes, household member's name: *

14. Been arrested for any offense? *

Yes No

If yes, household member's name: *

15. Do you have an outstanding personal judgement against you? *

Yes No

If yes, please explain: *

IF APPROVED WILL YOU COMPLY WITH ALL TERMS OF LEASE? *

Yes No

THE APPLICANT PRERESENTS THAT ALL INFORMATION IS TRUE AND CORRECT AND AUTHORIZES VERFICATION OF THE INFORMATION AND REFERENCES. THE PROVIDING OF UNTRUE OR INCORRECT INFORMATION SHALL BE GROUNDS TO REFUSE OR TERMIATE ANY RENTAL AGREEMENT. THE OWNER RESERVES THE RIGHTS TO REFUSE ANY APPLICANT FOR ANY REASON. THIS APPLICATION DOES NOT GUARANTEE TENANCY UNTIL THE RENTAL LEASE AGREEMENT HAS BEEN SIGNED, THE DEPOSIT MONEY HAS BEEN RECEIVED, AND THE PRESENT TENANT HAS VACATED THE PREMISES. NO PERSONS OTHER THAN THOSE SPECIFICALLY NAMED WILL BE PERMITTED TO OCCUPY THE DWELLING WITHOUT THE WRITTEN CONSENT OF THE LANDLORD.

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 statement 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 recognize that as a part of your procedure for processing my application, an 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 is true and correct.

Applicant's Name: *

Date *

Spouse's Name: *

Date *

Where may we reach you to discuss this application?

Phone: *

Apply

Application to Tenancy(319)-239-1387

Resident History

Previous Address #1

Applicant Employment Information

Previous Employer

Spouse's Employment Information

Spouse's Previous Employer

Financial Accounts and References

Other Income Sources

References

Personal References

Reference #1

Reference #2

Auto & Driver Information

Vehicle #1

Vehicle #2

Additional Questions

Have you ever. . .

Application to Tenancy

(319)-239-1387