Instructions: Please print, fill out the entire form, sign and fax to (614) 242-3738
Prospective Tenant must show adequate income (e.g. tax return or W-2) or other available funds to cover annual rent or Tenant will be required to have a co-signor (e.g. a parent) who can provide adequate security for the Prospective Tenant's rent obligation.
The undersigned hereby makes an application to rent unit #_____________ located at:
Anticipated move date of ___________________at a monthly rent of $_______________ and security deposit of
$_______________.
PLEASE TELL US ABOUT YOURSELF
Full Name__________________________________ Home Phone ___________________
Date of Birth__________________________________ Social Security #__________________________________
Email Address:_____________________________(optional) Other Phone ___________________
Co-Applicant Name_____________________________________Names of Dependents_________________________
Co-Applicant Date of Birth______________________ Social Security #_________________________________
Dependents Date of Birth______________________________________________________________________
List All Pets________________________________________________________________________________
PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)
Current Address______________________________ Apt#________ City__________________ State______ Zip________
Month/Year Moved In______________________ Reasons for Leaving_________________________Rent $__________
Owner/Agent______________________________________________Phone ____________________________
Previous Address (last 3 years)_____________________________________________________Rent $____________
Owner/Agent______________________________________________Phone ______________________
PLEASE DESCRIBE YOUR CREDIT HISTORY
Have you declared bankruptcy in the past seven (7) years?
Yes___________ No____________
Have you ever been evicted from a rental residence?
Yes___________ No____________
Have you had two or more late rental payments in the past year?
Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due?
Yes___________ No____________
PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION
Your Status:_____Full Time _____Part Time _____Student _____Unemployed
Employer________________________________________________________________________________________
Dates employed_______________________________ Employed as__________________________________________
Supervisor Name________________________________________Phone ______________________________
Salary $_________________per________________.(If employed by above less than 12 months, give name and phone of previous employer or school:________________________________________________________________________.)
If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.
Personal Reference or Emergency Contact:
Name _______________________________ Address _______________________________________________
Phone _______________________ Relationship_______________________
Driver's License:
Your Driver's License Number_________________ State_________________ Vehicle Information:
Make / Model _________________Year _________________ License Plate State_________________
ADDITIONAL INFORMATION:
Please give any additional information that might help owner/management evaluate this application?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Where may we reach you to discuss this application?
Day Phone #___________________________ Night Phone #____________________________
I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.
I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted in 3 business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When so approved and accepted, I agree to execute a lease for ___________ months before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason off non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, and investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.
The above information, to the best of my knowledge, is true and correct.
_______________________________________________
Name (please print)
X______________________________________________
Signature Date
AUTHORIZATION
Release of Information
I agree to permit an investigation of my credit, tenant history, banking and employment for the purposes of renting an apartment with this owner/manager.
_______________________________________________
Name (please print)
X______________________________________________
Signature Date
APPLICANT: PLEASE DO NOT WRITE BELOW; (FOR OFFICE USE ONLY)
Deposit of $__________________ Received by ____________________________ Date_______________