Property Rental Request

PROPERTY RENTAL REQUEST

Property Address:   Parcel / APN:

Applicant Information

Date of Birth:   Driver's License / ID #:

Phone:   Email:

Requested Rental Terms

Desired Move-In Date:   Lease Term (months):

Proposed Monthly Rent: $   Proposed Security Deposit: $

Pets: Yes    No    If yes, describe:

Smoking on Premises: Yes    No

Employment & Financial Information

Employer Address:

Position:   Supervisor Name:

Gross Monthly Income: $   Other Income (source/amount):

Rental History & References

Landlord Phone:   Duration at Address:

Phone:   Relationship:

Disclosures and Authorizations

Lead-Based Paint Disclosure Applicable (if property built before 1978):   Yes    No

Known Mold, Water Intrusion or Structural Damage:   Yes    No

Have you ever been evicted or had a rental agreement terminated?   Yes    No    If yes, explain:

Have you ever been convicted of a felony?   Yes    No    If yes, explain:

Application Fee Paid: Yes    No    Amount: $

Authorization and Certification

By signing below, Applicant certifies that all information provided in this Property Rental Request is true, complete and correct to the best of Applicant's knowledge. Applicant authorizes verification of credit, criminal, eviction, employment, rental history and other background checks as reasonably required by Landlord or its agent. Applicant understands that falsification, omission or misleading statements are grounds for denial of the request or subsequent termination of tenancy and for collection of damages and costs incurred by Landlord.

Applicant further acknowledges that submission of this request does not constitute approval, a binding lease, or a reservation of the property. Landlord may condition approval on execution of a separate lease agreement and payment of required deposits and fees. Landlord reserves the right to accept or reject the request in its sole discretion, subject to applicable fair housing and anti-discrimination laws.

Applicant hereby agrees to indemnify and hold Landlord harmless from any claim, loss or liability arising from Applicant's provision of false information. Applicant acknowledges receipt of any required written disclosures provided by Landlord at or before execution of a lease.

Default, Remedies & Governing Law

If Applicant makes material misrepresentations on this Request, Landlord may withhold approval or withdraw any offer of tenancy. Applicant agrees that any dispute arising from this Request or the evaluation process shall be governed by the laws of the state in which the property is located. Applicant acknowledges that Landlord may seek all remedies available at law or in equity for breach or misrepresentation, including recovery of costs and attorney's fees where permitted by law.

Additional Information

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