Room Rental Application Form

ROOM RENTAL APPLICATION FORM

Property Identification

Property Address:

Room/Unit Number:   Parcel / APN (if known):

Applicant Information

Date of Birth:   Last 4 of SSN:

Phone:   Email:

Co-Applicant (if any)

Phone:   Email:

Rental History (Past 5 Years)

Landlord Phone:   Monthly Rent:

Ever been evicted? Yes No

Employment and Income

Employer Phone:   Gross Monthly Income:

References and Emergency Contact

Occupants, Vehicles & Pets

Number of Occupants to Reside in Room:

Pets: Yes No

Proposed Rental Terms

Desired Move-In Date:   Proposed Monthly Rent:

Security Deposit Offered:   Desired Lease Term (months):

Check    Cash    Electronic / Transfer

Disclosures

Does applicant assert the presence of lead-based paint hazards on the property? Yes No Unknown

Is there known mold or water intrusion at the property? Yes No Unknown

Prior structural damage or major repairs disclosed: Yes No

Authorization, Consent and Acknowledgment

By signing below, Applicant authorizes the landlord or property manager and their agents to obtain consumer credit reports, tenant screening reports, criminal background checks, employment verification, and rental history verification as necessary to process this application. Applicant further authorizes current and former employers, landlords, and references to release information relevant to this application. Applicant understands that any false, misleading, or omitted information may constitute grounds for denial of the application or termination of tenancy if discovered after move-in.

Applicant acknowledges that submission of this application does not create a tenancy or binding lease. Acceptance of this application is conditioned upon satisfactory screening results, execution of a written lease, and timely payment of any required holding deposit or security deposit. Holding deposits may be non-refundable as specified by the landlord; applicant will be notified of such terms prior to payment.

Applicant consents to electronic communication for notices related to this application and any executed tenancy agreement, unless otherwise required by law.

Applicant affirms under penalty of perjury that the information provided in this application is true and complete to the best of their knowledge.

Background Questions

Have you ever been convicted of a felony? Yes No

Consent to Fee (if applicable)

Applicant understands that a non-refundable application screening fee may be required to process this application. By checking below Applicant agrees to pay the screening fee when requested.

Applicant agrees to fee

Signature and Certification

I certify that the foregoing information is true and correct. I understand that management may rely on this information in evaluating my application and that misstatements may result in denial or later termination of tenancy.

Sign Now