Prescreening Renal Questionnaire (Room For Rent)

Please read the following carefully before completing this form:

This is not a rental application. This form collects basic information about you and your move-in needs. There's no fees for this form. The purpose of this form is to determine whether you will get approved or not. So please fill out the form truthfully. This will save time and application fees for you if we can tell you upfront whether you will get approved or not. A thorough background check will be performed once the actual application and fees are submitted.
First and Last Name*
Gender*
Date of Birth

MonthDayYear
Date
Phone Number*
E-mail*
example@example.com
Occupation*
Move-In Classification*
Your Credit Rating*
Your Monthly Income (must be three times the rent to qualify on your own)*
If you do not qualify on your own, will you be able to provide a co-signer?*
Reason for Moving*
Lease Term*
Move-In Date

MonthDayYear
Date
Approx. Move-Out Date

MonthDayYear
Date
How many individuals will be moving in*
Which zip codes(s) would you like to reside?
What is your MAX rental amount?
How many bedrooms?
How many bathrooms?
Are you looking for a House for Apartment?

HouseApartmentOther
How many pets are you bringing?*
Are there any delinquency(ies) on your credit report?*

YesNo
Do you have funds available for the first month's rent?*

YesNo
Do you have funds available for the security deposit (usually one or two months' rent)?*

YesNo
Do you have previous landlord or management company reference available?*

YesNo
Do you smoke?*

YesNo
Are you currently employed?*

YesNo
Have you ever been evicted before?*

YesNo
What year were you evicted?*
Has there ever been any eviction court proceeding(s) that were filed against you ?*

YesNo
What year(s) were these court proceeding(s) filed against you?*
Have you ever been convicted of a misdemeanor or felony?*

YesNo
Was it a violent offense or non-violent offence?*

ViolentNon-Violent
Was it a misdemeanor or felony?*

MisdemeanorFelony
What year were you convicted?*
Are you a registered sex offender?*

YesNo
Do you own a gun?*

YesNo
Have you ever been sued by a Landlord?*

YesNo
Are you willing to take renter's insurance if required by the lease agreement?*

YesNo
Have you ever filed for bankrupcy?*

YesNo
What year did you file for bankruptcy?*
Please provide details about your conviction, what it was about and the outcome*
For each pet, provide type, breed (do not write mix), weight and height. *
Please provide names of roommates and relationship
Please verify that you are human*
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