Duplex Rental Application

DUPLEX RENTAL APPLICATION

Property Identification

Applicant Information

Applicant Name:

Date of Birth:    Phone:    Email:

Length of Residency:    Monthly Rent / Mortgage:

Employment and Income

Supervisor:    Employer Phone:

Position / Title:    Monthly Gross Income:    Length Employed:

Rental History (Previous 5 Years)

Landlord Name:    Landlord Phone:

Monthly Rent Paid:    Reason for Leaving:

Landlord Name:    Landlord Phone:

Monthly Rent Paid:    Reason for Leaving:

Occupants, Vehicles & Pets

Do you have pets? Yes No

Background Information

Have you ever been evicted? Yes No

Have you ever been convicted of a felony? Yes No

References & Emergency Contact

Lead-Based Paint & Property Condition

Is the dwelling unit built prior to 1978? Yes No

Applicant acknowledges receipt of any available lead-based paint information and understands that any known lead hazards related to the premises will be disclosed prior to lease execution. Applicant further acknowledges responsibility to promptly report any observed property defects or safety hazards to management.

Applicant Certification and Authorization

By signing below, Applicant certifies that all information provided in this application is true, complete and correct to the best of Applicant's knowledge. Applicant authorizes the landlord, manager, and their agents to verify all information provided, obtain credit and criminal background reports, and contact employers, landlords, and references to obtain information relevant to this application. Applicant acknowledges that false statements or omissions may constitute grounds for denial of tenancy or, if discovered after occupancy, termination of tenancy. Applicant further acknowledges that the landlord may retain a copy of this application whether or not tenancy is approved.

Application fee: Applicant acknowledges payment of an application processing fee, which may be non-refundable and used to cover the cost of screening and verification. Applicant further consents to the collection and use of personal information for screening purposes in accordance with applicable law.

Consent to Electronic Records: I consent to receive and sign records electronically.

Applicant Acknowledgements

I understand that completion of this application does not obligate the landlord to execute a lease or deliver possession. I understand that acceptance of a deposit or application fee does not create a tenancy until a lease has been signed by both parties. I authorize release of information to and from prior landlords, employers, and references for the purpose of verifying this application.

Applicant Initials:

Criminal Background and Screening Consent

Applicant authorizes the obtaining of criminal history, sex offender registry checks, and other public record searches as allowed by law. Applicant understands that conviction of certain offenses may be disqualifying. The landlord will consider the nature, date and relevance of any conviction in determining eligibility for tenancy.

Applicant Signature for Authorization:

Miscellaneous

Desired Move-In Date:    Desired Lease Term:

Proposed Monthly Rent:    Security Deposit Available:

Acknowledgement of Screening Fee

I acknowledge that a screening fee has been charged for processing this application and that such fee may be retained whether or not my application is approved. I acknowledge

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