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 (SAVING/ACCT.) ______________________________________ACCT.# __________________

NAMES OF PEOPLE WHO WILL BE LIVING AT THIS ADDRESS

NAME ____________________________________________RELATIONSHIP ___________________________

Page 2 of 3 RENTAL APPLICATION & INFORMATION RELEASE FORM

PERSONAL REFERENCES (NOT RELATED)

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 _________

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? ________________
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 ______________________________________ 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.

___________________________________________________________________ APPLICANT 1 SIGNATURE	_______________ DATE
___________________________________________________________________ APPLICANT 2 SIGNATURE	_______________ DATE

Page 3 of 3 RENTAL APPLICATION & INFORMATION RELEASE FORM

Do not write below this line

This section to be completed by interviewer

Credit Report: (Favorable/Unfavorable) _______________________________________________

Other Comments:_________________________________________________________________

Deposit:__________________ Option: _____________________ Monthly rent_______________

Term of Lease: ____________________________________________________________ months

Move in date: ______________ Lease Expires: _______________ Number of keys ____________

Total number of Occupants _________________________________________________________

Separate Pet Deposit (if any) ________________________________________________________

Utilities to be paid by Tenants: (GAS_______ ) (ELECTRIC_____) (WATER_____)

Trash pick up (If applicable) ________________________________________________________

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.