Rental Application

Landlord
DMA Properties, LLC
614 Vernon Rd
Cresco, IA 52136
563-419-0897

Full Name:*

Date of Birth:*

SSN:*

Phone:*

E Mail:*

example@example.com

Desired date of occupancy:

Date

Desired length of occupancy:

No. of Bedrooms:

Reason for moving:

No. of occupants: Adults*

No. of occupants: Children

Are you a smoker?

Do you have pets?

Have you ever been evicted from any rental premises?

If you answered yes, please explain here.

Have you ever willfully and intentionally refused to pay rent when due?

If you answered yes to the previous question, please explain.

Are there any circumstances which may interrupt your income or ability to pay rent?

If you answered yes to the previous question, please explain.

Have you ever been convicted of a felony?

If you answered yes to the previous question, please explain.

What is your current address?

How long have you been at this address?

Current landlord's name:

Phone number:

Current rent payment:

Prior address:

Prior landlord's name:

Prior landlord's phone number:

Prior rent payment:

Prior reason for moving:

Current employer:

Current job position:

Current employment duration:

Current employment annual income:

Prior Employer: (Only if you have been at your current job less than 12 months)

Prior employer:

Prior job position:

Prior employment duration:

Prior employment annual income:

PERSONAL REFERENCES: (non-family members)

(1) Personal reference name:

(1) Personal reference address:

(1) Personal reference phone number:

Please enter a valid phone number.

(1) Relationship to personal reference:

(2) Personal reference address:

(2) Personal reference phone number:

Please enter a valid phone number.

(2) Relationship to personal reference:

***IF A SECOND ADULT WILL BE RENTING THE PREMISES, THEY WILL NEED TO COMPLETE A SEPARATE RENTAL APPLICATION FORM. ***

I represent that the information provided in this Application is true and correct to the best of my knowledge. DMA Properties, LLC is authorized to verify the references and employment information given in this Application and to request a credit check.

Applicant's Signature

Date

IT IS AGAINST THE LAW TO DISCRIMINATE AGAINST PROSPECTIVE TENANTS ON THE BASIS OF RACE, RELIGION, NATIONAL ORIGIN, AGE, DISABILITY OR FAMILY STATUS. LOCAL OR STATE LAWS MAY INCLUDE ADDITIONAL CLASSES WHICH ARE PROTECTED FROM DISCRIMINATION IN HOUSING.

The information provided by the prospective tenant(s) may be used by DMA Properties, LLC to determine whether to accept this Application