Rental Agreement

Applicant information
Name:
Date of birth: Ssn: Phone:
Current address:
City: State: ZIP Code:
Own Rent (Please circle) Monthly payment or rent: How long?
Previous address:
City: State: ZIP Code:
Owned Rented (Please circle) Monthly payment or rent: How long?
Employment information
Current employer:
Employer address: How long?
Phone: E-mail: Fax:
City: State: ZIP Code:
Position: Hourly Salary (Please circle) Annual income:
Previous employer:
Address: How long?
Phone: E-mail: Fax:
City: State: ZIP Code:
Position: Hourly Salary (Please circle) Annual income:
Emergency Contact:
Address: Phone:
City: State: ZIP Code:
Relationship:
Credit cards
Name Account no. Current balance Monthly payment

Auto loans
Auto loans Account no. Balance Monthly payment

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Other loans, debts, or obligations
Description Account no. Amount

Other assets or sources of income

Description Amount per month or value

References
Name Relationship/Occupation Contact Information

Have you ever been evicted? Yes ___ no___ date ________

Have you ever been convicted of, pled guilty or no contest to any felony or misdemeanor?
Yes___ no___ If ‘yes’, where/when :

Automobile information

Pets?

Approval

Why are you vacating your present place of residence? ________________________________________________ Have you given
legal notice where you now live? Yes ____ no____

I certify that the above information is correct and complete and authorize you to do a credit check and make any inquiries you deem
needed to evaluate my tenancy and credit standing. I understand that giving incomplete or false information is grounds for rejection of
this application, and the submission of information later found to be false is grounds for termination of tenancy.

The landlord may obtain a consumer credit and/or investigative consumer report which may include the checking of the applicant’s
credit, employment, income, rental history, court records and character.

You have the right to request additional disclosures provided under section 606 1681d(b) of the fair credit reporting act, and a written
summary of your rights pursuant to section 609(c).

You have the right to dispute the accuracy of the information provided to the owner/agent by the screening company or the credit
reporting agency as well as complete and accurate disclosure of the nature and scope of the investigation

Applicant____________________________________________ date application submitted____________

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