Rental Application

Address you are applying for*
Desired move in date*
Name*
First Last
Date of Birth*
Month
Day
Year
Age
Email*
Enter Email Confirm Email
Current Phone Number*
Cell Phone Number
Marital Status*
Social Security #*
Driver's License #*
State*
Make/Year/License# of all vehicles*
Make Year License #
Number of Adult Applicants*
Co-Residents
Name Social Security # Relationship Date of Birth

Present Address
*
Street Address Address Line 2 City State ZIP Code
Landlord*
Landlord's Phone*
Fax
Amount of Rent
Date From*
Month
Day
Year
Date To*
Month
Day
Year
Previous Address
*
Street Address Address Line 2 City State ZIP Code
Landlord*
Landlord's Phone*
Fax
Amount of Rent
Date From*
Month
Day
Year
Date To*
Month
Day
Year

Employment
Employed By*
How Long?*
Business Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Email*
Position Held*
Gross Monthly Income*
Supervisor*
Spouse's Employer
Employed By*
How Long?*
Business Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Email*
Position Held*
Gross Monthly Income*
Supervisor*
Bank*
Bank Address*
Street Address Address Line 2 City State ZIP Code
Checking Account #*
Savings Account #

Rental Agreement
I DECLARE THAT THE FORGOING INFORMATION IS TRUE AND CORRECT. I AUTHORIZE THE VERIFICATION AND THE OBTAINING OF A CONSUMER CREDIT REPORT, VERIFICATION OF EMPLOYMENT, AND RENTAL VERIFICATION. AN APPLICATION FEE OF $26 PER INDIVIDUAL IS REQUIRED AND NONREFUNDABLE.
I agree that the Landlord may terminate any agreement due to any misstatement made above. I/We hereby deposit
Lease Length*
months before possession is given. If/We should back out of renting this property after three days, I/We shall forfeit the security deposit for lost rents or any expenses incurred trying to re-rent the property. If it is re-rented I/We shall be reimbursed any unused portion of said security deposit.
If this application is not approved and accepted by the owner or agent, the deposit will be refunded, the applicant hereby waiving any claim for damages by reason of non-acceptance which the owner or his agent may reject without reason for so doing.

Applicant(s) and or Prospective Tenants understand that the Landlord/Agent currently serves interest on behalf of the owner or owners of the property.
Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not taken care of properly. Lead exposure is especially harmful to young children and pregnant woman. Before renting pre-1978 housing, landlords must disclose the presence of known lead-based paint and lead-based paint hazards in the dwelling. Tenants must also receive a federally approved pamphlet on lead poisoning prevention.

Landlord has no knowledge of lead-based paint and/or lead based paint hazards in the housing and has no reports or records pertaining to lead-based paint and/or lead based paint hazards in the housing.

Agent has informed the owner of owner’s obligations under 42 U.S.C 4852(d) and is aware of his/her responsibility to ensure compliance.

By signing this agreement, tenant acknowledges having received the information concerning lead- based paint or lead-based paint hazards, read the above lead warning statement, and Tenant has received the pamphlet Protect Your Family from Lead in Your Home.
Signature of Applicant*
Date
MM slash DD slash YYYY
Signature of Second Applicant
Date
MM slash DD slash YYYY
Signature of Third Applicant
Date
MM slash DD slash YYYY
Application Fee*
Price:
Credit Card*
Card Details
Cardholder Name

Renter's Insurance Required

Step 1 of 6

Present Address

Previous Address

Employment

Spouse's Employer

In Case of Emergency - Notify: (Relative)

Rental Agreement

Lead Warning Statement

Make	Year	License #

Name	Social Security #	Relationship	Date of Birth