Applicant's Legal Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Drivers License State and Number
Photo Identification
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Last four of SSN
Do you have a Vehicle?
Yes
No
Vehicle Information
Rows
Model
Make
Year
Color
Type
License Plate #
1
2
3
4
Are all the vehicles listed operable and registered?
Occupation/Job Title?
Name of Company
Company Address
Manager's Name
Length of Employment with Company
Previous Employer Name and Number
Other sources of Income
What is your monthly gross income? ($)
What is your annual gross income? ($)
Please upload Proof of Income within the last 6 months
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Number of persons who will occupy the property
Please state the names of the other occupants and their relationship to the applicant.
Photo Identification of anyone over the age of 18
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Does anyone on the application smoke?
Do you have pets?
Yes
No
What type of Pet? Breed/Age/How long have you had them for?
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Duration of Occupancy
Reason(s) of leaving
Previous Landlord Name
First Name
Last Name
Previous Landlord Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you been evicted before?
Yes
No
If yes, please explain below:
Have you been convicted of any crime before?
Yes
No
If yes, please explain below:
Have you been convicted of felony before?
Yes
No
If yes, please explain below:
If you answered "yes" to any of the above, please attach any supportive documentation.
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Personal References:
Rows
Name
Address
Phone Number
Years Known
Relationship
1
2
Rental References
Rows
Name
Address
Phone Number
Years Known
1
2
Preference in Rental (ex. how many beds/baths/ fenced yard etc.)
Additional Information if Needed:
It is preferred that Applicants provide their records from the courts located in the town of which they resided for the last 10 years with the application. Both Riverton Circuit Courts provide this service for free with proof of ID. Location addresses: 1160 Major Ave. Riverton, 816 N. Federal Blvd. Riverton (This helps avoid application fee's)
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Preferred Move in date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Payment Method
Cash
Check/Money Order
Other
Please verify that you are human
*
Applicant's Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Co-Applicants Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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