RESIDENTIAL LEASE APPLICATION

Received on Date* (date) at Time* (time)
RESIDENTIAL LEASE APPLICATION
USE OF THIS FORM BY PERSONS WHO ARE NOT MEMBERS OF THE TEXAS ASSOCIATION OF REALTORS®, INC. IS NOT AUTHORIZED.
©Texas Association of REALTORS®, Inc. 2018
Each occupant and co-applicant 18 years or older must submit a separate application.
Property address *
Anticipated Move-in Date: *
Monthly Rent: $ *
Security Deposit: $ *
Initial Lease Term Requested: *
(months)
Property Condition: Applicant is strongly encouraged to view the Property prior to submitting any application. Landlord makes no express or implied warranties as to the Property's condition. Applicant requests Landlord consider the following repairs or treatments should Applicant and Landlord enter into a lease:
Applicant was referred to Landlord by:

Real estate agent Newspaper Sign Internet Other
If referred by a real estate agent. Name: Realtor name Phone: Phone E-mail: Email
Applicant's name (first, middle, last)
Is there a co-applicant?

Yes. If yes, co-applicant must submit a separate application. No
Email *
example@example.com
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Mobile/Pager
Please enter a valid phone number.
Soc. Sec. No.
###-##-####
Driver License No.
Driver License State
(state)
Date of Birth *

Month Day Year
Citizenship:
(country)
Marital Status
Height
Weight
Eye Color
Hair Color
Emergency Contact:(Do not insert the name of an occupant or co-applicant.)
Name:
Emergency contact name
Address:
Phone:
Please enter a valid phone number.
Email:
example@example.com
Name all other persons who will occupy the Property:
Name: Occupant name Relationship: Relation to self Age: Age
Name: Occupant name Relationship: Relation to self Age: Age
Name: Occupant name Relationship: Relation to self Age: Age
Name: Occupant name Relationship: Relation to self Age: Age
Applicant's Current Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landlord or Property Manager's Name:
Email:
example@example.com
Phone: (day)
(000) 000-0000
Phone: (night)
(000) 000-0000
Mobile:
(000) 000-0000
Fax:
(000) 000-0000
Date Moved-In:
Move-Out Date::
Rent $
Reason for move:
Applicant's Previous Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landlord or Property Manager's Name:
Email:
example@example.com
Phone: (day)
(000) 000-0000
Phone: (night)
(000) 000-0000
Mobile:
(000) 000-0000
Fax:
(000) 000-0000
Date Moved-In:
Move-Out Date::
Rent $
Reason for move:

(TXR-2003) 2-1-18

Page 1 of 4

Century 21 John Walton Realtors
Phone: (806) 793-8111
Fax: (806) 799-2188
4718 S Loop 289 Lubbock TX 79414

Residential Lease Application concerning
Authorization: Applicant authorizes Landlord and Landlord's agent, at any time before, during, or after any tenancy, to:
1. obtain a copy of Applicant's credit report;
2. obtain a criminal background check related to Applicant and any occupant; and
3. verify any rental or employment history or verify any other information related to this application with persons knowledgeable of such information.
Notice of Landlord's Right to Continue to Show the Property: Unless Landlord and Applicant enter into a separate written agreement otherwise, the Property remains on the market until a lease is signed by all parties and Landlord may continue to show the Property to other prospective tenants and accept another offer.

Privacy Policy: Landlord's agent or property manager maintains a privacy policy that is available upon request.
Fees: Applicant submits a non-refundable fee of $ toblank (entity or individual) for processing and reviewing this application. Applicant submits will not submit an application deposit of to be applied to the security deposit upon execution of a lease or returned to Applicant if a lease is not executed.
Acknowledgement & Representation:

(1) Signing this application indicates that Applicant has had the opportunity to review Landlord's tenant selection criteria, which is available upon request.The tenant selection criteria may include factors such as criminal history, credit history, current income and rental history.

(2) Applicant understands that providing inaccurate or incomplete information is grounds for rejection of this application and forfeiture of any application fee and may be grounds to declare Applicant in breach of any lease the Applicant may sign.

(3) Applicant represents that the statements in this application are true and complete.
Applicant's Signature Clear
Month Day Year
Date

(TXR-2003) 2-1-18

Page 3 of 4

Century 21 John Walton Realtors
Phone: (806) 793-8111
Fax: (806) 799-2188
4718 S Loop 289 Lubbock TX 79414

Residential Lease Application concerning
AUTHORIZATION TO RELEASE INFORMATION
RELATED TO A RESIDENTIAL LEASE APPLICANT
USE OF THIS FORM BY PERSONS WHO ARE NOT MEMBERS OF THE TEXAS ASSOCIATION OF REALTORS®, INC. IS NOT AUTHORIZED.
©Texas Association of REALTORS®, Inc. 2018
Each occupant and co-applicant 18 years or older must submit a separate application.
I, (Applicant), have submitted an application to lease a property located at (address, city, state, zip).

The landlord, broker, or landlord's representative is:

Century 21 John Walton Realtors			(name)
4718 S Loop 289			(address)
Lubbock, TX 79414			(city, state, zip)
(806) 793-8111	(phone)	(806) 799-2188	(fax)
c21rentals@c21johnwalton.com			(email)

I give my permission:

(1) to my current and former employers to release any information about my employment history and income history tothe above-named person;

(2) to my current and former landlords to release any information about my rental history to the above-named person;

(3) to my current and former mortgage lenders on property that I own or have owned to release any information aboutmy mortgage payment history to the above-named person;

(4) to my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to theabove-named person; and

(5) to the above-named person to obtain a copy of my consumer report (credit report) from any consumer reportingagency and to obtain background information about me.
*

Applicant's Signature Clear
*

Month Day Year
Date
Note: Any broker gathering information about an applicant acts under specific instructions to verify some or allof the information described in this authorization. The broker maintains a privacy policy which is available uponrequest.

(TXR-2003) 2-1-18

Page 4 of 4

Century 21 John Walton Realtors
Phone: (806) 793-8111
Fax: (806) 799-2188
4718 S Loop 289 Lubbock TX 79414

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	Type	Year	Make	Model	License Plate No. / State	Monthly Payment
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	Type & Breed	Name	Color	Weight	Age in Years	Gender	Neutered	Declawed	Rabies Shots Current	Bite History
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	Yes	No
Will any waterbeds or water-filled furniture be on the Property?
Does anyone who will occupy the Property smoke?
Will Applicant maintain renter's insurance?
Is Applicant or Applicant's spouse, even if separated, in military?
If yes, is the military person serving under orders limiting the military person's stay to one year or less?

	Yes	No
been evicted?
been asked to move out by a landlord?
breached a lease or rental agreement?
filed for bankruptcy?
lost property in a foreclosure?
had any credit problems, including any outstanding debt (e.g., student loans or medical bills), slow-pays or delinquencies?
been convicted of a crime? If yes, provide the location, year, and type of conviction below.
Is any occupant a registered sex offender? If yes, provide the location, year, and type of conviction below.
Is there additional information Applicant wants considered?