RENTAL APPLICATION

P.O. Box 11, Carroll, Iowa 51401 712-792-2917 info@westerniowaliving.com
RENTAL APPLICATION
Neatly complete all information below. All applicants over the age of 18 must complete and sign their own application.
Address of property applying for*
UNIT Requested

Studio1 Bedroom2 Bedroom
Applicants Full Name*
Phone*
DOB*
Email Address*
example@example.com
Social Security #*
State*
State*
Exp*
Address*

Current Address

Street Address Line 2

CityState

Zip
Current Landlords Name*
Landlords Phone*
How long at this address*
Reason for leaving*
Auto:
Yr*
Make*
Model*
License Plate*
Color*
Employer:
Present Employer*
Position*
Mo. Income*
How Long*
How Long*
Other Income*
Employers Address

Have you ever been party to an eviction? ( ) Yes. ( ) No. Any past small claims judgements ( ) Yes. ( ) No.City:Type of Account:State:
Address*

Employers Address

Street Address Line 2

CityState

Postal / Zip Code
Name of bank*
Type of Account*
If yes explain*
Personal References:
Name*
Relationship*
Relationship*
Phone#*
Name*
Relationship*
Relationship*
Phone#*
Emergency Contact Name*
Address*
Total number of adults (each needs an ap):
Names of all other applicants*
Names of all other applicants*
Names of all other applicants*
Total number of children living with you under the age of 18*
I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this
application for tenant screening as may be necessary in arriving at the tenant decision, I understand that the landlord may terminate any rental agreement entered into for any misrepresentations made above.*

Clear
Date*

MonthDayYear
Date
Please Return to Court Street Plaza during office hours, Mail to PO Box 11, Carroll, IA 51401, or email to info@courtstreetplaza.com
Court Street Plaza
Lincoln Highway Suites
Jefferson Apartments
514 North Court Street Carroll, Iowa51401
117 East 6th Street Carroll, Iowa 51401

215 South Wilson Avenue Jefferson, Iowa 50129
Should be Empty:

RENTAL APPLICATION

Auto:

Employer:

Personal References:

Court Street Plaza

Lincoln Highway Suites

Jefferson Apartments