Rental Application Form

Today's Date* Applicant's Name (last, first, middle initial)* Address (street, city, state, and zip code)* How long at present address? (years)* Phone Number* E-Mail Address* Name & Phone number of landlord or manager (if applicable) Have you ever been evicted?* Yes No If yes, please explain: Have you even broken a rental agreement or lease contract?* Yes No If yes, please explain: Have you ever been sued for non-payment of rent or damages to rental property?* Yes No If yes, please explain: Marital status* Single Married Divorced Widowed Separated Date of Birth* Driver's License #:* State of Issue:* AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware DC District of Columbia FL Florida GA Georgia HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregon PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming Present Employer* Employer's Address (street, city, state, and zip code):* Work Phone:* How Long Employeed?* Type of Work Performed* 1st Emergency Contact Name:* 1st Emergency Contact Address (street, city, state, and zip code):* 1st Emergency Contact Phone:* 1st Emergency Contact Relationship:* 2nd Emergency Contact Name:* 2nd Emergency Contact Address (street, city, state, and zip code):* 2nd Emergency Contact Phone:* 2nd Emergency Contact Relationship: How were you referred to us?* Drive by Newspaper Referral Telephone Book Previous Customer Website Internet Other Applicant acknowledges that all of the above statements are true and complete, and hereby authorizes verification of above information, references, and credit records. Applicant acknowledges that false information herein may constitute grounds for rejection of this application, termination of right of occupancy and/or forfeiture of deposits and may constitute a criminal offense under the laws of this state.*

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