Rental Application

Rental Application
First Name*
Last Name*
Phone Number*
Desired Date of Occupancy*

MonthDayYear
Desired Length of Occupancy*
Number of Bedrooms*
Number of Adult Occupants*
Number of Children Occupants*
Social Security Number*
Date of Birth*
Reason for Moving*

Address Information
Present Address*
How Long at Prior Address*
Landlord's Name*
Landlord's Phone Number*
Current Rent Payment*
Prior Address
How Long at Prior Address?
Landlord's Name
Landlord's Phone Number
Rent Payment
Reason for Moving

Sources of Income & Employment
Employer*
Job Title*
Length at Employer*
Employer Phone Number*
Gross Income (Before Taxes)*
Additional Income

Child SupportAlimonyGovernment Assistance
Child Support Amount
Alimony Amount
Government Assistance Amount

Personal References
Name
Address
Phone Number
Relationship
Name
Address
Phone Number
Relationship

Co-Applicant
Co-Applicant Name
Social Security Number
Date of Birth
Cell Phone Number
Present Address
How Long at Present Address
Employer
Job Title
Length at Employer
Employer Phone Number
Gross Income (Before Taxes)
Additional Income

Child SupportAlimonyGovernment Assistance
Child Support Amount
Alimony Amount
Government Assistance Amount

Other Tenants
Please provide names of other tenants, including children and anyone who will live with you, even if on a temporary basis.
Names of Additional Tenants
Ages of Additional Tenants

Pets
Do You Have Pets?*

YesNo
Name
Type/Breed
Size
Lives

IndoorsOutdoors
Name
Type/Breed
Size
Lives

IndoorsOutdoors

Signatures
I represent that the information provided in this Application is trust and correct to the best of my knowledge. JJS Modern Properties is hereby authorized to contact my references and employers to verify the information I have provided and those persons or entities named above are hereby authorized to provide information to JJS Modern Properties regarding the information I have provided. JJS Modern Properties is authorized to obtain a credit report so that it can verify the
information I have provided and determine that I am credit worthy.
Applicant's Signature

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Co-Applicant's Signature

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