RESIDENTIAL LEASE APPLICATION

RESIDENTIAL LEASE APPLICATION

Each occupant and co-applicant 18 years or older must submit a separate application.
Property Address
Anticipated Move-in Date:

MonthDayYear
Date
Anticipated Monthly Rent: $
Anticipated Security Deposit: $
Initial Lease Term Requested (months):
Property Condition: Applicant has has not viewed the Property in-person prior to submitting this application.
Applicant is strongly encouraged to view the Property in-person 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:
Real estate agentNewspaperSignInternetOther
Agent's Name
Agent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Agent's Email
example@example.com

Employment

Note: If Applicant is self-employed, Landlord may require one or more previous year's tax return attested by a CPA, attorney, or other tax professional.
Applicant's Current Employer:
Address (street, city, state, zip):
Employment Verification Contact:
Phone:
Fax:
Email:
example@example.com
Start Date:

MonthDayYear
Date
Gross Monthly Income: $
Position
Applicant's Previous Employer:
Address (street, city, state, zip):
Employment Verification Contact:
Phone:
Fax:
Email:
example@example.com
Employed from:

MonthDayYear
Date
Employed to:

MonthDayYear
Date
Gross Monthly Income: $
Position:
Describe other income Applicant wants considered:

Authorization:

Applicant authorizes Landlord and Landlord's agent, at any time before, or after any tendency 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.
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 $75.00 to Kubenka Real Estate Solutions for processing and reviewing this application. Applicant submits will not submit an application deposit of $blanks 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. (4) Applicant is responsible for any costs associated with obtaining information.
Applicant's Signature

Clear
Date

MonthDayYear
Date

I, blanks (Applicant), have submitted an application to lease a property located at blank (address, city, state, zip).
Applicant's Signature

Clear
Date

MonthDayYear
Date
Type a question
Should be Empty:

Rows	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?

Rows	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?
been convicted of a crime? If yes, provide the location, year, and type of conviction
Is any occupant a registered sex offender? If yes, provide the location, year, and type of conviction below.
had any credit problems, slow-pays or delinquencies? If yes, provide more information below.
Is there additional information Applicant wants considered?

Emergency Contact: