Personal Information
APPLICANT (Self)
CO-APPLICANT (If Applicable)
First Name
First Name
Middle Name
Middle Name
Last Name
Last Name
Date Of Birth
Date Of Birth
Drivers License Number
Drivers License Number
Social Security Number
Social Security Number
Cell Phone Number
Cell Phone Number
E-Mail Address
E-Mail Address
E-Mail Address (2nd)
E-Mail Address (2nd)
Residential History (Last 2-3
Places)
PRESENT:
PRESENT:
Street
Street
Apt Number
Apt Number
City
City
State
State
Zip
Zip
Phone Number
Phone Number
Landlords Name
Landlords Name
Landlords Phone Number
Landlords Phone Number
Landlords E-Mail Address
Landlords E-Mail Address
Rent / Payment Amount
Rent / Payment Amount
Date Started Living Here
Date Started Living Here
Reason For Leaving
Reason For Leaving
PAST:
PAST:
Street
Street
Apt Number
Apt Number
City
City
State
State
Zip
Zip
Phone Number
Phone Number
Landlords Name
Landlords Name
Landlords Phone Number
Landlords Phone Number
Landlords E-Mail Address
Landlords E-Mail Address
Rent / Payment Amount
Rent / Payment Amount
Date Started Living Here
Date Started Living Here
Date Ended Living Here
Date Ended Living Here
Reason For Leaving
Reason For Leaving
Employment History (Last 2-3 Places)
PRESENT:
PRESENT:
Company Name
Company Name
Monthly Wages (Specify Hourly/Salary)
Monthly Wages (Specify
Hourly/Salary)
Tips (If Used As Income)
Tips (If Used As Income)
Address
Address
City
City
State
State
Zip Code
Zip Code
Phone Number
Phone Number
Supervisor First Name
Supervisor First Name
Supervisor Last Name
Supervisor Last Name
Supervisors Number (If Different)
Supervisors Number (If Different)
Date Started Employment Here
Date Started Employment Here
PAST:
PAST:
Company Name
Company Name
Monthly Wages (Specify Hourly/Salary)
Monthly Wages (Specify
Hourly/Salary)
Tips (If Used As Income)
Tips (If Used As Income)
Address
Address
City
City
State
State
Zip Code
Zip Code
Phone Number
Phone Number
Supervisor First Name
Supervisor First Name
Supervisor Last Name
Supervisor Last Name
Supervisors Number (If Different)
Supervisors Number (If Different)
Date Started Employment Here
Date Started Employment Here
Date Ended Employment Here
Date Ended Employment Here
Reason For Leaving
Reason For Leaving
PAST:
PAST:
Company Name
Company Name
Monthly Wages (Specify Hourly/Salary)
Monthly Wages (Specify
Hourly/Salary)
Tips (If Used As Income)
Tips (If Used As Income)
Address
Address
City
City
State
State
Zip Code
Zip Code
Phone Number
Phone Number
Supervisor First Name
Supervisor First Name
Supervisor Last Name
Supervisor Last Name
Supervisors Number (If Different)
Supervisors Number (If Different)
Date Started Employment Here
Date Started Employment Here
Date Ended Employment Here
Date Ended Employment Here
Reason For Leaving
Reason For Leaving
Bank Information
Name Of Bank
Name Of Bank
Branch Location
Branch Location
Branch Phone Number
Branch Phone Number
Type Of Account(s)
Type Of Account(s)
Account Number(s)
Account Number(s)
Credit History
Do you have additional income?
Do you have additional income?
If YES , How much a month?
If YES , How much a month?
Declared bankruptcy in the past 7 years?
Declared bankruptcy in the past 7
years?
If YES , when?
If YES , when?
Have you ever been evicted?
Have you ever been evicted?
If YES, when?
If YES, when?
Have you ever willfully or intentionally -
Have you ever willfully or
intentionally -
refused to pay rent when it was due?
refused to pay rent when it was due?
Personal References (Two Need To Be
Non-Relative)
First Name
First Name
Last Name
Last Name
City
City
Phone Number
Phone Number
E-Mail Address
E-Mail Address
Relationship To You
Relationship To You
Occupation
Occupation
First Name
First Name
Last Name
Last Name
City
City
Phone Number
Phone Number
E-Mail Address
E-Mail Address
Relationship To You
Relationship To You
Occupation
Occupation
First Name
First Name
Last Name
Last Name
City
City
Phone Number
Phone Number
E-Mail Address
E-Mail Address
Relationship To You
Relationship To You
Occupation
Occupation
Miscellaneous Questions
Have you been convicted of a crime?
Have you been convicted of a crime?
If YES when?
If YES when?
If YES, for what?
If YES, for what?
Have you used a different name?
Have you used a different name?
If YES, what was it? (First-Middle-Last)
If YES, what was it?
(First-Middle-Last)
Do you smoke?
Do you smoke?
Do you have pets?
Do you have pets?
If YES, how many?
If YES, how many?
If YES, what kind?
If YES, what kind?
How many vehicles do you have?
How many vehicles do you have?
Are they all currently licensed?
Are they all currently licensed?
Do you currently have renters insurance?
Do you currently have renters
insurance?
If YES, with who?
If YES, with who?
What is the policy number?
What is the policy number?
What is your agents name?
What is your agents name?
What is the agents phone number?
What is the agents phone number?
Do you give authorization to obtain
Do you give authorization to obtain
a copy of your credit report?
a copy of your credit report?
Will any OTHER adults live in the house?
If YES, how many?
What are there age(s)?
Will any minors live in the house full time?
If YES, how many?
What are there age(s)?
Will any minors live in the house part time?
If YES, how many?
What are there age(s)?
Do any of these people smoke?
By signing this form I have knowingly given all
information as accurately as I know it to be. I agree to
permit
an investigation of my credit, tenant, banking and
employment for the purposes of renting with this owner.
________________________________________________________
________________________________________________________
Please sign and date the above line
Please sign and date the
above line