Date: __________
Application is hereby made to rent premises generally described as
_________________ for a term of __________ and ending the _____ day of
__________, 20___, for which monthly rental shall be __________, payable
in advance, and for which a security deposit of $ __________ shall be due
prior to occupancy of the above-described premises.
A deposit of __________ is made herewith on account of the first month's
rent, with the understanding that if this application is accepted and the
applicant fails to execute a lease before the beginning date specified
above, or to pay the balance due as first month's rent, said payment will
be forfeited as liquidated damages. It is also understood that if this
application is not accepted, or if the premises are not ready for
occupancy by the applicant on the date specified above, said deposit
shall be refunded to the applicant forthwith, upon applicant's request.
APPLICANT
Name: ________________________ SS #: _______________
Driver's Lisc. #: _______________________ State: _______
Present Address: __________ How Long? __________
Previous Address: __________ How Long? __________
Married: __________
Spouse's Name: __________
Children? __________ How Many? __________ Ages? __________
Pets? __________ What Kind? __________ How Many? __________
YOUR EMPLOYMENT
Employer: __________
Employer Address: __________
Supervisor: __________
Bus. Phone: __________
How Long on Present Job? __________
Annual Income: __________
SPOUSE'S EMPLOYMENT
Employer: __________
Employer Address: __________
Supervisor: __________
Bus. Phone: __________
How Long on Present Job? __________
Annual Income: __________
REFERENCES
Bank: __________ Phone: __________
Personal Reference: __________ Phone: __________
Credit Reference: __________ Phone: __________
Credit Reference: __________ Phone: __________
The information provided herein may be used by the landlord or his agent to
determine whether to accept this application. Upon written request within
____ days, the landlord or his agent will disclose to applicant in writing
the nature and scope of any investigation landlord has requested, and will,
if this application is refused, state in writing the reason for said
refusal.
Accepted __________ Refused __________
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