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Rental Application & Information Release Form 1st APPLICANT’S NAME ____________________________________________________________________ MAIDEN NAME _______________________ SOCIAL SECURITY # _________________________________ BIRTHDAY _________________DRIVERS LIC.# _____________________________ STATE_____________ 2nd APPLICANT’S NAME____________________________________________________________________ MAIDEN NAME _______________________ SOCIAL SECURITY # _________________________________ BIRTHDAY _________________DRIVERS LIC.# _____________________________ STATE_____________ 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 ________________ LANDLORD'S NAME___________________________ LANDLORD'S ADDRESS_____________________________________________________________________ PHONE # (_____)_______________ WHAT MONTH & YEAR DID YOU MOVE IN? ___________________ 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_________________________ PREVIOUS LANDLORD'S NAME ________________________________ PHONE # (_____)_______________ EMPLOYMENT REFERENCES: 1st APPLICANT’S EMPLOYER_________________________________________________________________ EMPLOYER'S ADDRESS _______________________________________ PHONE # (_____)_______________ SUPERVISOR'S NAME _________________________DEPT __________ PHONE # (_____)_______________ LENGTH OF TIME EMPLOYED ______ YRS. _____MONTHS, POSITION____________________________ MONTHLY INCOME $_____________________ ANY ADDITIONAL INCOME $_______________________ 2nd APPLICANT’S EMPLOYER_________________________________________________________________ EMPLOYER'S ADDRESS ________________________________________ PHONE # (_____)_______________ SUPERVISOR'S NAME __________________________DEPT __________ PHONE # (_____)_______________ LENGTH OF TIME EMPLOYED ______ YRS. _____MONTHS, POSITION_____________________________ MONTHLY INCOME $_____________________ ANY ADDITIONAL INCOME $________________________ BANKING REFERENCES: BANK NAME (CHECKING/ACCT.)____________________________________ACCT.# __________________ BANK NAME (CHECKING/ACCT.)____________________________________ACCT.# __________________ BANK NAME (SAVING/ACCT.) ______________________________________ACCT.# __________________ NAMES OF PEOPLE WHO WILL BE LIVING AT THIS ADDRESS NAME ____________________________________________RELATIONSHIP ___________________________ NAME ____________________________________________RELATIONSHIP ___________________________ NAME ____________________________________________RELATIONSHIP ___________________________ NAME ____________________________________________RELATIONSHIP ___________________________ NAME ____________________________________________RELATIONSHIP ___________________________ Page 2 of 3 RENTAL APPLICATION & INFORMATION RELEASE FORM PERSONAL REFERENCES (NOT RELATED) NAME _____________________ADDRESS _________________________ PHONE # (_____)_______________ NAME _____________________ADDRESS _________________________ PHONE # (_____)_______________ NAME _____________________ADDRESS _________________________ PHONE # (_____)_______________ MOTHER'S NAME _____________________________________________ PHONE # (_____)_______________ MOTHER'S ADDRESS_________________________________________________________________________ FATHER'S NAME ______________________________________________ PHONE # (_____)_______________ FATHER'S ADDRESS__________________________________________________________________________ IN CASE OF EMERGENCY CONTACT: NAME _______________________________________________________ PHONE # (_____)_______________ ADDRESS ____________________________________________________RELATIONSHIP________________ NAME _______________________________________________________ PHONE # (_____)_______________ ADDRESS ____________________________________________________RELATIONSHIP________________ VEHICLES OWNED: AUTO LIC.PLATE #_____________________STATE __________MAKE _______________YEAR _________ AUTO LIC.PLATE #_____________________STATE __________MAKE _______________YEAR _________ AUTO LIC.PLATE #_____________________STATE __________MAKE _______________YEAR _________ HAVE YOU EVER BEEN CONVICTED OF A [ ]FELONY, [ ]MISDEMEANOR? If yes explain: ________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ HAVE YOU EVER GONE THROUGH BANKRUPTCY,
BEEN EVICTED, HAD ANY JUDGEMENTS, CREDITORS OR OTHER LEGAL PROCEEDING
AGAINST YOU? ________________ ____________________________________________________________________________________________ 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 ______________________________________ 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 ________________________________________ 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. I HAVE READ THE ABOVE AND I AM IN COMPLETE AGREEMENT WITH IT.
Page 3 of 3 RENTAL APPLICATION & INFORMATION RELEASE FORM
INFORMATION RELEASE FORM I/we hereby authorize ______________________________________ 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 _________________________________________ 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.
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