House Rental Application

Rental Application Form
Date of Application

MonthDayYear
Date
1st Applicant Information
Property Address You Are Applying For
Name*

First NameLast Name
Date of Birth*

MonthDayYear
DOB
Social Security*
Driver's License*
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Last grade of School completed?
School name
City/State
Current Address of the Applicant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
2nd Co-Applicant Information

(see attached application for additional information)
Name*

First NameLast Name
Date of Birth*

MonthDayYear
DOB
Social Security*
Driver's License*
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Last grade of School completed?
School name
City/State
Current Address of the Applicant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Desired date of move in?
Number of adults moving in?
Total number of people moving in?
How long do you plan to stay?
How did you hear about this house?
Residence History

Rows	Current	Previous
Street Address
City, State and Zip code
Move in date
Move out date
Landlord name / Telephone
Landlord Address
Rent amount
Are you related? if so, how?

** If you have lived in other residencies in the last 3 years, please list those all
OTHER INCOME (Social Security, SSI, SSA, Child Support, etc...

Rows	Years	Months
How long have you been receiving this income?

Rows Amount

Case Worker’s Name

Rows	Amount
Case Worker’s Name

Rows	Weekly $	Bi-weekly	Monthly $	Semi-monthly $
How often are you paid?

Employment History
Present Position
Employer Name
Supervisor's Name

First NameLast Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
Date
Monthly Gross Income
Position
Previous Position
Employer Name
Supervisor's Name

First NameLast Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Start Date

MonthDayYear
Date
Monthly Gross Income
Position
Are you using Section Eight, FIA, or using aid to pay your rent?
Name of Agency Paying You Rent
If yes, how long have you been receiving aid?

YearsMonths
Case Worker’s Name
Case Worker’s phone #
If you pay all utilities, what is the max rent amount?

Sec 8 portion $Your portion $
Financial Information
Do you have a savings account?
Name of Bank:
Do you have a checking account?
Please list the utilities that you currently pay:
**Bring a copy of each bill with application submission**
Vehicle Information

Rows	Make	Model	Year	License Plate

Emergency Contact / Reference-1:
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact / Reference-2:
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Pets

Rows	Type	Height	Weight

This application is hereby submitted for consideration as a tenant. The landlord hereby reserves the right to return any applicant without stating a reason for doing so. Rights of tenancy begin when the tenant(s) and the landlord sign the lease agreement.

Receipt of a deposit in the amount of $ is hereby acknowledged. If the tenant is accepted and changes their mind after 24 hours of application acceptance the landlord will be entitled to RETAIN THE FULL DEPOSIT as consideration for reservation of the rental unit (which could result in the loss of other potential tenants and additional repair expenses paid in advance to maintenance workers).

Applicant hereby grants permission to landlord and or landlord’s agents to make a thorough personal investigation of the applicant, including but not limited to credit checks, rental history and criminal history, now and at any time in the future which may in any way pertain to this proposed tenancy and also to report to a credit bureau(s) and /or other interested parties the way in which applicant may pay on this account. Applicant understands that an incomplete, inaccurate, false, and/or misleading statement made on this application is/are sufficient grounds for this application to be denied.

The applicant has the necessary money for the first month’s rent AND and security deposit amount agreed upon with the owner. Once the applicant is accepted they will be given a date and time to sign the lease, pay said monies, and be given keys and possession of the house. Signing this application means you can pay the monies needed and take possession of the home. Failure to do so will disqualify you as an applicant.
Application must be completely filled out and signed to be processed
Applicant Signature
Date

MonthDayYear
Date
Applicant Signature
Date

MonthDayYear
Date
Owner / Agent Signature
Date

MonthDayYear
Date
Please scan any one of the following QR payment methods to make the payment
Should be Empty:

Rental Application Form

1st Applicant Information

2nd Co-Applicant Information

Residence History

Employment History

Present Position

Previous Position

Financial Information

Vehicle Information

Emergency Contact / Reference-1:

Emergency Contact / Reference-2:

Pets

Application must be completely filled out and signed to be processed