Residential Landlord Application

RESIDENTIAL LANDLORD APPLICATION

This application is an offer to lease and contains authorization for the landlord or its agent to verify the information provided, including obtaining consumer credit reports, criminal background checks, eviction records, employment and income verification, and contacting personal references. Completion of this application does not constitute approval of tenancy. False statements made in this application are grounds for denial or, if tenancy is granted, immediate termination.

Property and Lease Information

Desired Move-In Date:   Lease Term (months):   Number of Occupants:

Applicant Information

Date of Birth:   Social Security Number:

How long at current address? From: To:

Previous Residence (if less than 3 years at current)

Previous Landlord:   Phone:

Employment and Income

Position:   Supervisor:

Financial and References

Occupants, Pets & Vehicles

Do you have pets? Yes No

Background and Disclosures

Have you ever been evicted? Yes No

Have you ever been convicted of a felony or crime? Yes No

Lead-Based Paint Disclosure: Lead-based paint may exist in properties built prior to 1978. Lead Paint Present? Yes No

Known Mold or Water Damage: Yes No

Prior Structural or Fire Damage Repaired: Yes No

Authorization and Certification

I, the undersigned applicant, certify under penalty of perjury that all information in this application is true, complete and accurate. I authorize the landlord, property manager, and their agents to obtain consumer credit reports, criminal background checks, eviction records, and to verify all statements herein, including employment, income, rental history and references. I authorize any person or entity contacted to release such information to the landlord or its agent. I release and hold harmless all persons and entities providing information in good faith from any liability arising from disclosure of such information.

Applicant acknowledges that payment of any application fee is a separate, non-refundable charge to cover the cost of processing this application and obtaining screening reports. Payment of a fee does not guarantee approval. Applicant agrees to notify the landlord promptly of any material changes to information provided herein.

By signing below, applicant certifies that all information is accurate and consents to the verifications described above.

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