RentalApplication

first month's rent. When your application is accepted, the check will be deposited. If your application

is not accepted, your check will be returned.

Last Name:________________________ First:___________________

Middle:___________________________

Social Security:__________________________________ Date of Birth: ________________________

Maiden Name:_______________

Current Address: _______________________________________________________________

                 Number        Street           City           State    Zipcode

How long there? ___________________ Reason for leaving:______________________

Name of Owner or Agent: ________________________

Previous Address: ______________________________________________________________

                  Number        Street           City            State   Zipcode

How long there? _____________________ Reason for leaving: ____________________

Name of Owner or Agent: ________________________

Prior Address: __________________________________________________________________

               Number           Street            City            State   Zipcode

How long there? ____________________ Reason for leaving:_______________________

Name of Owner or Agent: ________________________

Employer: ________________________ How long: ________________________

Employed as: ________________________ Salary: ________________________ Phone:

________________________

Address: ________________________ Supervisor: ________________________

Checking Account #: ________________________ Bank & branch: ________________________

Savings Account #: ________________________ Bank & branch: ________________________

Drivers License/State ID#__________________ State (DL# or State ID)________________

In case of emergency, name and address of two nearest relatives not living with you:

Name: ________________________ Relationship: ________________________

Address: ________________________ Phone: ________________________

Name: ________________________ Relationship: ________________________

Address: ________________________ Phone: ________________________

I authorize the agent for owner of this property to verify the above information and obtain a credit

report. I understand that when my application is accepted, the accompanying earnest money check will be

deposited, but that if my application is not accepted, my check will be returned uncashed. I certify

that there are sufficient funds in my account to cover the earnest money check which is being tendered

with this application. This is an equal housing opportunity.

Date:____________________ SIGN HERE:_________________________

Phone:________________________

Address of Rental Unit:___________________________________