Rental Application

Deb Fridy Rentals

561 E. Ross Lane, Danville, IL 61832

217.443.8101 FAX (855) 326-1586

deb@fridyrealty.com

What are you interested in renting?

Applicant Information

Name

First NameLast Name

Birthday

MonthDayYear

When do you want to move?

YesNo

Present Address

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Phone Number

Area CodePhone Number

How long have you lived in Vermilion County?

What other names have you used?

Current Landlord Information

Name

First NameLast Name

Phone Number

Area CodePhone Number

How long at present residence?

Back Rent owed & Amount

Reason for leaving

Residence History For The Past 3 Years

(Excluding current landlord)

#1 Landlord Name

First NameLast Name

Landlord Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

How long at this address?

YesNo

Past Rent Owed

#2 Landlord Name

First NameLast Name

Landlord Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

How long at this address?

YesNo

Past Rent Owed

Employment & Income Information

Employer

How long employed?

Employer Phone Number

Area CodePhone Number

Wage

HourWeek

Other Sources of Income

Number of hours worked per week

Please provide the following credit information

YesNo

Where?

YesNo

Where?

Vehicle information

Make

Year

License #

Who should we contact in case of an emergency?

Emergency Contact #1

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Emergency Contact #2

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

List 2 Personal References

Personal Reference #1

First NameLast Name

Relationship

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Personal Reference #2

First NameLast Name

Relationship

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Please list all adults and children that will be living at this address and their relationship

Name #1

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #2

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #3

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #4

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #5

First NameLast Name

Relationship

Birthday

MonthDayYear

By signing this application, I am giving my consent for D. Fridy to make inquiries and obtain such reports as may be available from any sources necessary to give them a clear picture of my credit and/or criminal history. Providing false or inaccurate information will result in being denied rental housing.

Please type your first name and last name below. This will act as your signature which will allow me to contact the references you listed in your application.

Applicant's Signature

First NameLast Name

Applicant Information

Name

First NameLast Name

Birthday

MonthDayYear

When do you want to move?

YesNo

Present Address

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Phone Number

Area CodePhone Number

How long have you lived in Vermilion County?

What other names have you used?

Current Landlord Information

Name

First NameLast Name

Phone Number

Area CodePhone Number

How long at present residence?

Back Rent owed & Amount

Reason for leaving

Residence History For The Past 3 Years

(Excluding current landlord)

#1 Landlord Name

First NameLast Name

Landlord Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

How long at this address?

YesNo

Past Rent Owed

#2 Landlord Name

First NameLast Name

Landlord Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

How long at this address?

YesNo

Past Rent Owed

Employment & Income Information

Employer

How long employed?

Employer Phone Number

Area CodePhone Number

Wage

HourWeek

Other Sources of Income

Number of hours worked per week

Please provide the following credit information

YesNo

Where?

YesNo

Where?

Vehicle information

Make

Year

License #

Who should we contact in case of an emergency?

Emergency Contact #1

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Emergency Contact #2

First NameLast Name

Relationship

Personal Reference #3

First NameLast Name

Phone Number

Area CodePhone Number

List 2 Personal References

Personal Reference #1

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Relationship

Phone Number

Area CodePhone Number

Personal Reference #2

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Relationship

Phone Number

Area CodePhone Number

Please list all adults and children that will be living at this address and their relationship

Name #1

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #2

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #3

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #4

First NameLast Name

Relationship

Birthday

MonthDayYear

Name #5

First NameLast Name

Relationship

Birthday

MonthDayYear

By signing this application, I am giving my consent for D. Fridy to make inquiries and obtain such reports as may be available from any sources necessary to give them a clear picture of my credit and/or criminal history. Providing false or inaccurate information will result in being denied rental housing.

Please type your first name and last name below. This will act as your signature which will allow me to contact the references you listed in your application.

Co-applicant's Signature

First NameLast Name

Rental Application

Co-applicant fill-out this part of the application.