Online Rental/Rent to Own Application

Please enter all fields to the best of your ability! This application is subject to a background check at any time. The information entered into this form will not be sold or given out to anyone except for the background check.

Personal information

First name Middle name

Last name Birth date

Email Address

Drivers License#

Have you used any other names in the past?

Yes
No

If yes

All other names used
First Name	Middle Name	Last Name

Name(s) in which your utilities are now billed
First name	Middle name	Last name

Home phone Cell phone

All other proposed occupants
First Name	Middle Name	Last Name	Age	Relationship

Current Residence

Current Residence Street Address, City, State and Zip
Street Address	City	State	Zip code

Last rent amount paid

Owner/Manager
First name	Last name	Phone number

Reason for leaving

Is/Was rent paid in full?

Yes
No

Did you give notice?

Yes
No

Were you asked to move?

Yes
No

Dates of Residency From To

Previous Residence

Previous Residence Street Address, City, State and Zip
Street Address	City	State	Zip code

Last rent amount paid

Owner/Manager
First name	Last name	Phone number

Reason for leaving

Is/Was rent paid in full?

Yes
No

Did you give notice?

Yes
No

Were you asked to move?

Yes
No

Dates of Residency From To

Prior Residence

Prior Residence Street Address, City, State and Zip
Street Address	City	State	Zip code

Last rent amount paid

Owner/Manager
First name	Last name	Phone number

Reason for leaving

Is/Was rent paid in full?

Yes
No

Did you give notice?

Yes
No

Were you asked to move?

Yes
No

Dates of Residency From To

Current Employment

Company Employed by

Street Address, City, State and Zip
Street Address	City	State	Zip code

Occupation Monthly Gross Pay

Employer/Manager
First name	Last name	Phone number

Dates of Employment From To

Previous Employment

Company Employed by

Street Address, City, State and Zip
Street Address	City	State	Zip code

Occupation Monthly Gross Pay

Employer/Manager
First name	Last name	Phone number

Dates of Employment From To

Prior Employment

Company Employed by

Street Address, City, State and Zip
Street Address	City	State	Zip code

Occupation Monthly Gross Pay

Employer/Manager
First name	Last name	Phone number

Dates of Employment From To

Balance on or Balance Owed

Savings account Checking account

Credit cards
Card Name	Balance	Card limit

Auto Loans
Loan holder	Balance	Time left on loan

Vehicles

Vehicles you own to be parked on the property
Make	Model	Color	Year	License plate #

Other Proposed Occupants Vehicles

Vehicles to be parked on the property
Make	Model	Color	Year	License plate #

References and Emergency Contacts

Primary Doctor
First Name	Last Name	Address

City	State	Zip	Phone

Lawyer
First Name	Last Name	Address

City	State	Zip	Phone

Nearest Relative Living Elsewhere
First Name	Last Name	Address

City	State	Zip	Phone

Other Questions

Have you ever been served a late rent notice?
Yes
No

If yes How many times?

When was the last one?

Do any of the people who would be living in the apartment smoke?
Yes
No

How long do you think you would be renting from us?
Less than 1 month
1-6 months
6-12 months
More than 12 months

Have you ever filed for bankruptcy?
Yes
No

If yes How many times?

When was the last one?

When would you like to move in?
Right now
1-7 days
1-4 weeks
More than a month

Have you ever been convicted of a felony?
Yes
No

If yes How many times?

When was the last one?

Have you ever been served an eviction notice?
Yes
No

If yes How many times?

When was the last one?

How many pets do you have?
Type	Breed	Weight	Age

Have you had any reoccurring problems with your current apartment or landlord?
Yes
No

If yes, please explain

List any verifiable sources and amounts of income you wish to have considered (optional but this can help you if you don't have enough the required amount of income for the apartment that you are applying for.)

If you were to run into financial difficulty in the future and couldn’t come up with the money to pay the rent, do you know someone that would loan you the money? If so, provide the person’s name, address, and phone number so that we can use them as a reference for you.
First Name	Last Name	Address

City	State	Zip	Phone

Have you been a party to a lawsuit in the past?
Yes
No

If yes, please explain

We may run a credit check and a criminal background check. Is there anything negative we will find that you want to comment on?

How did you hear about this apartment?

What city would you like to live in?

How many bedrooms do you need?

How much do you plan on spending for rent?

Did you see a property on this website that you are interested in? if so list the address here.
Address	City	State	Zip

Do you know of anybody else looking for an apartment?
Yes
No

If yes, please provide their information. If you refer a friend and you each end up renting separate apartments from us then we will pay you a referral reward.
First Name	Last Name	Phone Number	E-mail

I believe that the statements I have made are true and correct. I hereby authorize a credit and/or criminal check to be made, verification of information I provided and communication with any and all names listed on this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for an apartment and does not constitute a rental or lease agreement in whole or part. Any questions regarding rejected applications must be submitted in writing and accompanied by a self-addressed stamped envelope. By signing the application you grant us permission to communicate with all the contacts listed in this section. In the event we cannot locate you. Furthermore, if you abandon the apartment for any reason then you grant us permission to allow your relative listed above to remove all contents of the dwelling on your behalf.

Signature

Date

Questions or comments