Rental Application & Information Release Form
1st APPLICANT’S FIRST NAME LAST NAME
MAIDEN NAME_ SOCIAL SECURITY #
BIRTHDAY EX: 01/01/2001 DRIVERS LIC.# _ STATE
2nd APPLICANT’S FIRST NAME LAST NAME
PRESENT RESIDENCE INFORMATION
PRESENT ADDRESS _CITY_ STATE
ZIP CODE PHONE #
Is this your telephone: Yes No
If not, whose telephone is it:
HOW LONG AT THIS ADDRESS (NUMBER OF YEARS) 0 1 2 3 4 5 OVER 5 YEARS MONTHS 0 1 2 3 4 5 6 7 8 9 10 11
LANDLORD'S NAME
LANDLORD'S ADDRESS PHONE #
\WHAT MONTH & YEAR DID YOU MOVE IN ? JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER YEAR
WHAT NAME IS USED BY GAS & ELECTRIC CO. FOR BILLING?
WHAT NAME IS USED BY THE PHONE COMPANY FOR BILLING?
WHAT NAME IS USED FOR WATER COMPANY FOR BILLING?
WHERE DO YOU PAY YOUR RENT: Number Street
City State Zip code
WHY ARE YOU MOVING?
HOW MUCH IS YOUR CURRENT RENT? $
PREVIOUS ADDRESS CITY _ STATE
PREVIOUS LANDLORD'S NAME PHONE #
EMPLOYMENT REFERENCES:
1st APPLICANT’S EMPLOYER
EMPLOYER'S ADDRESS PHONE #
SUPERVISOR'S NAME DEPT PHONE #
LENGTH OF TIME EMPLOYED _ 0 1 2 3 4 5 OVER 5 YEARS YRS. 0 1 2 3 4 5 6 7 8 9 10 11 MONTHS, POSITION
MONTHLY INCOME $ ANY ADDITIONAL INCOME $
2nd APPLICANT’S EMPLOYER
SUPERVISOR'S NAME _DEPT PHONE #
LENGTH OF TIME EMPLOYED 0 1 2 3 4 5 OVER 5 YEARS YRS 0 1 2 3 4 5 6 7 8 9 10 11 MONTHS, POSITION
BANKING REFERENCES:
BANK NAME (CHECKING/ACCT.) _ACCT.#
BANK NAME (SAVING/ACCT.) ACCT.#
NAMES OF PEOPLE WHO WILL BE LIVING AT THIS ADDRESS
NAME RELATIONSHIP
PERSONAL REFERENCES (NOT RELATED)
NAME ADDRESS PHONE #
MOTHER'S NAME PHONE
MOTHER'S STREET ADDRESS CITY ZIP
FATHERS FIRST NAME LAST NAME PHONE
FATHERS STREET ADDRESS CITY ZIP
IN CASE OF EMERGENCY CONTACT:
NAME PHONE #
ADDRESS RELATIONSHIP
VEHICLES OWNED:
AUTO LIC.PLATE # STATE_ MAKE YEAR
HAVE YOU EVER BEEN CONVICTED OF A FELONY, YES NO ]MISDEMEANOR ? YES NO
If yes explain:
HAVE YOU EVER GONE THROUGH BANKRUPTCY, BEEN EVICTED, HAD ANY JUDGMENTS, CREDITORS OR OTHER LEGAL PROCEEDING AGAINST YOU? YES NO
IF yes, explain:
PROPERTY ADDRESS OF RESIDENCE YOU ARE APPLYING TO RENT:
NUMBER OF BEDROOMS: _ RENT PER MONTH IS $
A NON-REFUNDABLE CREDIT CHECKING FEE OF $20.00 IS DUE AT THE TIME THE RENTAL APPLICATION IS FILLED OUT.
I/we hereby authorize A1LANDLORD and associates and/or any Credit Information Services to obtain information concerning my past credit, and/or tenant-landlord history now or anytime in the future. I hereby authorize any of the following sources, including but not limited to landlords, public or privately owned utilities, current or past creditors, governmental housing agencies, and/or other credit reporting agencies to release any information to A1LANDLORD and associates or any Credit Information Service concerning my/our past credit and/or tenant-landlord history. I hereby release any of the above sources, their officers, agents, or employees from any liability for damages of whatsoever kind or nature whether caused by negligence or otherwise which may at any time result to me/us by reason of compliance with the above mentioned inquiry which may include the answering of specific questions and the giving of any information concerning my/our past records.
BY ENTERING MY EMAIL ADDRESS BELOW I HAVE READ THE ABOVE AND I AM IN COMPLETE AGREEMENT WITH IT.
