Rental Application Form

Please fill in all the blanks as detailed as possible

Property Address:

Lease Term: start date:
Lease Term: duration in month:

Proposed Monthly Rent:

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Authorization for Credit and Background Check: Applicant hereby authorizes Owner and any authorized agent of Owner (“Agent”) to do whatever background and credit check on Applicant that the Owner or Agent deem appropriate. This may include among other things obtaining one or more credit reports on Applicant. Such credit report(s) may be obtained before and during the term of the Lease and after the expiration or termination of the Lease as part of any effort to collect rent, costs, fees and charges owing under such Lease. Applicant acknowledges that merely requesting such reports may lower Applicant’s credit score and Applicant expressly consents to the same.
I authorize it

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Use of Information: The information in this application or obtained as a result of the authorization given herein by Applicant will not be sold or distributed to others. However, Owner or Agent may use such information to decide whether to lease the Property to Applicant and for all other purposes relative to any future lease agreement between the parties including the enforcement thereof.
Agree

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Application Does Not Create a Lease : This application, even if accepted, shall under no circumstances be considered a lease agreement between Applicant and Owner or an offer to lease. No lease shall exist between Applicant and Owner unless and until the parties enter into a formal Lease Agreement and Applicant pays all required fees, deposits and advance rent.
Acknowledged

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Warranty of Applicant : Applicant hereby warrants that the information supplied above is complete and accurate and that the breach of this warranty by Applicant may result in the termination of any Lease entered into with Applicant by Owner.
Acknowledged

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Commitment to Equal Housing : Owner and Agent are committed to providing equal housing opportunities to all rental applicants regardless of race, color, religion, national origin, sex, handicap or familial status.
Acknowledged

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Reason for Denial : If this Application is denied, Owner or Agent shall within ten (10) days thereafter and upon the written request of applicant, state the basis for said denial to Applicant.
Acknowledged

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I have visited the Property and had the opportunity to inspect it: I understand that I am accepting the Property "as is" except for any stipulations, changes or modifications that are listed as contingencies of this application. If any stipulations cannot be met, or an acceptable compromise agreed to by all parties, I understand that any fees I have paid with the submission of this Rental Application will be returned to me.
visited and inspectednot yet visited or seen in person

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I understand that Agency NA LLC(Broker/Management) is the Agent and representative for the owner of the Property and will be paid a fee by the owner. I also understand that this Property is being leased As-Is in its present condition. I understand that Management prefers that I see the Property in person and conduct any inspections of the Property which I might desire, at my own expense, prior to applying for the Property.
YesNo

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General Applicant Information

First Name:

Middle Name:

Last Name:

SS#:

Date of Birth:

Driver’s License #:

Driver’s License State:

Home phone:

Work phone:

Cell phone:

Email :

Emergency Contact Information(name/phone):

Spouse/Significant Other Name(must fill out a separate application)

Names and ages of individuals under 18:

Pets:
YesNo

Pets, what kind?(if yes above):

Pets, how many?

Pet weight:

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Residence history

Current Address:

City/State/Zip:

How long?

Current Lease Amount:

Landlord Name:

Landlord Phone:

Landlord Address:

Reason for Leaving:

Previous Address:

City/State/Zip:

How Long?

Lease Amount:

Previous Landlord Name:

Previous Landlord Phone:

Previous Landlord Address:

Reason for Leaving:

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Employment

Employer:

Position:

Employer Address:

City/State/Zip:

Supervisor:

Business Phone:

Length of Time at Present Job:

Annual Income:

Previous Employer:

Position:

Employer Address:

City/State/Zip:

Supervisor:

Business Phone:

Length of Time at Present Job:

Annual Income:

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Other Matters

Do you have a legal right to be in the US?
Yes, I am a U.S. CitizenNo, I need helpYes, I have valid documentation from the Bureau of Citizenship and Immigration Service

If you answered "Yes" because you are a non-U.S. citizen with valid visa documentation, please provide:
Reason you are in the US:
Visa Type:
Visa Expiration Date:

Have you ever been asked to move out of a residence?
YesNo

Have you ever been party to an eviction?
YesNo

Are you a registered sex offender?
YesNo

Do you have liquid furniture?(i.e. waterbed)
YesNo

Do you have renter insurance?
YesNo

Have you ever filed bankruptcy?
YesNo

Has bankruptcy been discharged or dismissed?
YesNo

Have you ever had any debt collection actions against you?
YesNo

Type in today’s Date:

Applicant Full Name:

Attach driver's license image: pdf or photo images:

Attach pay stubs image: pdf or photo images