Room Rental Application Form
Applicant Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you smoke?
Yes
No
Are you a Convicted Felon?
Yes
No
Have you ever been Evicted?
Yes
No
Are you active military or a veteran?
Yes
No
Emergency Contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current landlord Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Start Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Employment
Company Name
Starting Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
Title
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Salary $
Monthly
Reference
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Notes
Proof of Employment/Income
Employment/Income Proof
*
Browse Files
Drag and drop files here
Choose a file
Employment Letter, Two Months Pay Stubs, etc.
Cancel
of
Driver's License
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Move-in Cost/ Payment Method
Are you able to pay the $360.00 move in deposit? Do you understand and agree that $300 will be refunded 7-10 days after check-out without any incidents or damages. $60 is non-refundable for the room cleaning fee.
*
Yes
No
Other
Do you understand and agree that your $360 deposit is broken down for the following: 1. $150 for any room incidentals, 2. $150 holds your room for 30 additional days (which means your room is only secured for the month you pay plus the month after-renews at the beginning of every month paid). 3. $60.00 non-refundable move-out cleaning fee.
*
Yes
No
Other
Are you able to pay your first month (we do not accept week by week) room rent fee? Do you understand and agree that this is not a lease but is a month by month stay. Rent is due the 1st of every month before 11am. If rent is not paid you will not get your new key code for the property therefore, you will be locked out of the property.
*
Yes
No
Other
Do you understand and agree that this is a shared space, so you are only renting a room. You have access and use of the common areas and must clean up behind yourself after each use of the common areas. Do you understand that this is part of the house rules and can be grounds for cancellation of your stay?
*
Yes
No
Other
Do you understand and agree that if any house rules are broken this will be grounds for immediate cancellation of your stay.
*
Yes
No
Other
Do you understand and agree that pets are not allowed. There are some people in our staff that is highly allergic to pets.
*
Yes
No
Other
Do you understand and agree that our properties are not child proof therefore we are unable to accommodate any child under 13 years of age.
*
Yes
No
Other
Do you understand and agree we are a smoke free and drug free property.
*
Yes
No
Other
Do you understand and agree that the toiletries and linen given upon check in are starters only and any additional will have to be acquired by you.
*
Yes
No
Other
What Payment Method do you plan to use?
*
Cash
Zelle
Venmo App
Square Cash App
Paypal
Google Pay
Other
Submit
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