Property address:

PERSONAL INFORMATION (You are on a secure server – all information is kept in complete confidentiality)
First NameMiddle NameLast NameSocial Security #
DOBMaritalStatusDriver's License #State
Home PhoneCell PhoneWork PhoneEmail
Present Home AddressCity/State/ZipPresent LandlordPresent Landlord Phone
Length of TimeReason for leavingPresent Amount of RentIs your rent up to date?
Previous Home AddressPrevious City/State/ZipPrevious LandlordPrevious Landlord Phone
Reason for leavingLength of timePrevious Rent AmountWas your rent up to date?
Next Previous Home AddressCity/State/ZipNext Previous LandlordNext Previous Landlord Phone
Reason for leavingLength of timeNext Previous Rent AmountWas your rent up to date?
PROPOSED OCCUPANTS
Occupant 1OccupationRelationshipAge
Occupant 2OccupationRelationshipAge
Occupant 3OccupationRelationshipAge
Occupant 4OccupationRelationshipAge
Occupant 5OccupationRelationshipAge
PROPOSED PET(S)
Pet 1Breedindoor/outdoorAge
Pet 2Breedindoor/outdoorAge
Pet 3Breedindoor/outdoorAge
VEHICLE(S) INFORMATION
Year 1MakeModelColorPlateState
Year 2MakeModelColorPlateState
EMPLOYMENT
EmployerOccupationHours per week
SupervisorPhoneExt.
AddressCity/State/ZipYears Employed

EmployerOccupationHours Per Week
SupervisorPhoneExt.
AddressCity/State/ZipYears Employed
INCOME
Current IncomeSourceProof of Income
Current IncomeSourceProof of Income
Current IncomeSourceProof of Income
CREDIT CARD/FINANCIAL INFORMATION
Car Loan LienholderBalance OwedMonthly PaymentCreditor's Phone Number
Credit Card CompanyBalance OwedMonthly PaymentCreditor's Phone Number
Credit Card CompanyBalance OwedMonthly PaymentCreditor's Phone Number
Credit Card CompanyBalance OwedMonthly PaymentCreditor's Phone Number
Child Support
/Other Credit Owed
Balance OwedMonthly PaymentOther Creditor's Phone Number
Bank NameBalanceMonthly PaymentAccount Number
EMERGENCY/PERSONAL REFERENCE INFORMATION
Emergency ContactPhonePhone
RelationAddressCity/State/Zip
Emergency ContactPhonePhone
RelationAddressCity/State/Zip
Personal ReferencePhonePhone
RelationAddress City/State/Zip
Personal ReferencePhonePhone
RelationAddressCity/State/Zip
APPLICANT QUESTIONNAIRE/AUTHORIZATION
Has applicant ever been sued for bills?Has applicant ever been locked out of their apartment by the sheriff?
Has applicant ever been bankrupt?Has applicant ever been brought to court by another landlord?
Has applicant ever been guilty of a felony?Has applicant ever moved owing rent or damaged an apartment?
Has applicant ever broken a lease?Is the total move-in amount available (rent and deposit)?

Applicant authorizes the landlord to contact past and present landlords, employers, creditors, credit bureaus, neighbors, and any other sources deemed necessary to investigate applicant. All information is true, accurate and complete to the best of applicant's knowledge. Landlord reserves the right to disqualify tenant if information is not represented. ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM AT ANY TIME.
 
Applicant Signature (type full name) Signature Date
NOTES

If you have any questions about the interpretation or legality of this form, please consult an attorney or other qualified person.