General Information
Last Name:
First Name:
Middle Initial:
Previous Names:
Phone Number(s):
Email Address:
Driver's license state and number:
Social Security number:
Date of birth mm/dd/yyyy:
What property are you looking at renting?
Why are you looking at renting this property at this time?
Emergency Contact
Name:
Address:
Phone:
Email:
Prior Address History - Most Recent or Current Address
Street Address:
City:
State:
Zip Code:
Date Occupancy Started:
Date Occupancy Ended:
Reason for moving in:
Reason for moving out:
Own or rent: Own Rent
(If Rent) List name and phone number of landlord or leasing company:
Prior Address History - Former Address
Street Address:
City:
State:
Zip Code:
Date Occupancy Started:
Date Occupancy Ended:
Reason for moving in:
Reason for moving out:
Own or rent: Own Rent
(If Rent) List name and phone number of landlord or leasing company:
Prior Address History - Former Address
Street Address:
City:
State:
Zip Code:
Date Occupancy Started:
Date Occupancy Ended:
Reason for moving in:
Reason for moving out:
Own or rent: Own Rent
(If Rent) List name and phone number of landlord or leasing company:
Personal Reference #1
Name:
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Relationship:
Years Known:
Personal Reference #2
Name:
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Relationship:
Years Known:
Personal Reference #3
Name:
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Relationship:
Years Known:
Eviction History
Have you ever been evicted from a rental property? Yes No
(If YES, please explain in detail):
Employment History - Present or Most Recent Employer
Name of Employer:
Job Title / Duties
Supervisor:
Phone:
Email:
Hiring Date:
End Date (if applicable):
Reason for starting this job:
Reason for leaving this job (if applicable):
Current Pay: $
Per Day
Per Week
Bi-Weekly
Monthly
Can you provide a copy of your last two paycheck stubs? Yes No
(If NO, please explain):
Employment History - Former Employer
Name of Employer:
Job Title / Duties
Supervisor:
Phone:
Email:
Hiring Date:
End Date (if applicable):
Reason for starting this job:
Reason for leaving this job (if applicable):
Employment History - Former Employer
Name of Employer:
Job Title / Duties
Supervisor:
Phone:
Email:
Hiring Date:
End Date (if applicable):
Reason for starting this job:
Reason for leaving this job (if applicable):
Additional Sources of Income
Additional sources of income you would like considered:
Bankruptcy
Have you ever declared bankruptcy? Yes No
If YES, please explain:
Criminal History
Have you ever been convicted of any felony? Yes No
Are you a convicted sex offender? Yes No
If YES to EITHER, please explain:

I understand that false, fictitious, or misleading answers on this questionnaire may, at the sole discretion of the Lessor, result in immediate termination of any lease entered into at any point in the future between Lessor and Lessee.

Furthermore, I grant permission to the Lessor to contact whomever Lessor sees fit to verify the accuracy of the information contained herein at any time.

Furthermore, I understand that this questionnaire does not represent any lease agreement in and of itself, and that neither Lessor or Lessee is obligated to enter into a lease agreement simply as a result of this questionnaire.

Furthermore, I hereby authorize the person or firm to whom this application is submitted to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement.

Furthermore, I understand that Lessor specifically requests no information be filled in which I am not legally required to disclose, including, but not limited to, information protected under court order, witness protection program, any military or government intelligence agency, Americans with Disability Act, Fair Housing Act, or any other means. Any such information which I have elected to disclose herein, was done so of my free will, and not at the request of Lessor.