Rental Stay Application

RENTAL STAY APPLICATION

Property Identification

Property Address:

Applicant Information

Date of Birth:    Social Security Number:

How long at current address:    Current Rent / Mortgage:

Desired Tenancy & Financials

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

Employment & Income Verification

Employer Phone:    Length of Employment:

Rental History & References

Previous Landlord:    Reason for Leaving:

Relationship:    Phone:

Occupants, Pets & Vehicles

Number of Occupants:    Names of Occupants:

Pets: Yes    If yes, describe:

Background & Disclosures

Have you ever been evicted or asked to vacate a residence? Yes    Have you ever filed bankruptcy in the past seven years? Yes

Have you been convicted of a felony or a crime involving drugs or violence? Yes    If any answer is Yes, provide details:

Applicant acknowledges receipt of the following property disclosures: Lead-based paint, known mold/water intrusion, and prior material damage. Lead-based paint disclosure provided: Yes    Known mold/water intrusion disclosed: Yes    Known prior material damage disclosed: Yes

Authorization and Certification

By signing this application, Applicant certifies that all statements and representations made in this application are true, complete and correct. Applicant authorizes verification of all information provided, including but not limited to, credit reports, criminal history, eviction history, employment, income, and rental history. Applicant releases from liability any person, current or former employer, landlord, credit bureau or other entity who provides information to the prospective landlord or agent in accordance with this authorization.

Applicant acknowledges that the application fee is non-refundable and that submission of this application does not constitute a lease or a promise to lease. Acceptance of this application is contingent upon satisfactory screening and, if accepted, Applicant understands that false statements or omissions are grounds for immediate denial or later termination of tenancy.

Applicant agrees that, upon acceptance, any holding deposit will be applied toward the security deposit or first month's rent in accordance with terms to be provided separately. Applicant understands that landlord may terminate consideration if verification results are unsatisfactory.

Additional Information

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