Rental_Application

Tenant Name

Date of Birth

Social Security #

Mothers Maiden Name

Phone

Drivers License #

Present Address

City

State

Zip Code

How Long

Landlord

Phone

Previous Address

City

State

Zip Code

How long

Monthly Income

Take-home Pay

Source (circle):

wages commission gov’t assistance salary tips other

Other Tenants

Name

Age

Relationship

Occupation

Name

Age

Relationship

Occupation

References

Name

Phone

Relationship

Name

Phone

Relationship

Have you ever been evicted?

Have you ever intentionally refused to pay rent when due?

I hereby certify that the answers I have given in this application are true and correct to the best of my knowledge. I understand that any false answers or statements made by me will be sufficient grounds for eviction and loss of any security deposit. Applicant permits and agrees to pay a fee of $10 for a credit check to be performed on him/herself and his/her co-occupant by his/her signature below.

Date

Tenant

Co-tenant

Discrimination: It is against the law to discriminate against tenants on the basis of race, religion, national origin, age, or neighborhood racial makeup.