DUPLEX-SOUTH RENTAL APP FORM

RESIDENTIAL RENTAL APPLICATION

For inquiries about the rental property, please contact Jessica Borgelt at:

Email Address: property@jborgeltdesign.com

Phone: (402) 380-5797

Rental Property Address: 1904 Avenue M, Wisner, NE 68791

Date of Availability: Immediately

Monthly Rent Payment: $1,600.00

Initial Security Deposit: $1,600.00

APPLICANT'S PERSONAL INFORMATION
Name
Date of Birth

MonthDayYear
Date
DESIRED MOVEIN DATE

MonthDayYear
Date
CO-APPLICANT'S PERSONAL INFORMATION (if applicable)
Name
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
OTHER OCCUPANTS' INFORMATION (if applicable)
Name
Relation to Applicant
Date of Birth

MonthDayYear
Date
Name
Relation to Applicant
Date of Birth

MonthDayYear
Date
Residential Rental Application
How long have you been residing at this address
Monthly Rent
Landlords Name
Landlords Contact Number
Reasons for leaving this property
II. Previous Residence (If applicable)
Previous Address
How long did you stay at this address
Monthly Rent
Landlords Name
Landlords Contact Number
Reasons for leaving this property
Have you ever been evicted from a rental residence?
Yes
No
Have you missed two or more rental payments in the past 12 months?
Yes
Have you ever refused to pay rent when due?
Yes
No
If you have answered YES to any of the above, please state your reasons and/or
Residential Rental Application
circumstances
EMPLOYMENT DETAILS
Full-Time []Part-time]Student[]Unemployed [ ] [[ Employment Status:]
Retired
Current Employer
Supervisors Name
Job Title
Date Hired

MonthDayYear
Date
Monthly Income
Other Sources of Income
Previous Employer if any
Supervisors Name
Job Title
Period of Employment
CREDIT HISTORY AND BACKGROUND CHECK AUTHORIZATION
Have you declared bankruptcy in the past seven (7) years? Do you consent to a credit check? Is there anything that we may find in our credit check that you want to comment
Residential Rental Application

The Landlord does not allow pets in the rental property.

The Landlord does not allow smoking of cigarettes in the rental property.

The Landlord does not allow the use of waterbeds on the premises.

The rental property includes 2 parking spaces in the form of Attached Garage for the

I declare that the information I have provided is true and correct, and contains no misrepresentations. If misrepresentations are found after a residential lease agreement is entered into between the Landlord and Applicant, the Landlord shall have the option to terminate the residential lease agreement and seek all available remedies.

The Applicant authorizes the Landlord to verify all references and facts, including but not limited to current and previous landlords, employers and personal references. The Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing or may result in the denial of the application.
Residential Rental Application
Applicants Signature

Clear
Date

MonthDayYear
Date
CoApplicants Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

EMPLOYMENT DETAILS

CREDIT HISTORY AND BACKGROUND CHECK AUTHORIZATION