Rental Application

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?
Do you have Section 8?

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?
Do you owe past rent?

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?
Do you owe past rent?

YesNo
Past Rent Owed
Employment & Income Information
Employer
How long employed?
Employer Phone Number

Area CodePhone Number
Wage
Per Hour or Week?

HourWeek
Other Sources of Income
Number of hours worked per week
Please provide the following credit information
Do you have a checking account?

YesNo
Where?
Do you have a savings account?

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
Co-applicant fill-out this part of the application.
Applicant Information
Name

First NameLast Name
Birthday

MonthDayYear
When do you want to move?
Do you have Section 8?

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?
Do you owe past rent?

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?
Do you owe past rent?

YesNo
Past Rent Owed
Employment & Income Information
Employer
How long employed?
Employer Phone Number

Area CodePhone Number
Wage
Per Hour or Week?

HourWeek
Other Sources of Income
Number of hours worked per week
Please provide the following credit information
Do you have a checking account?

YesNo
Where?
Do you have a savings account?

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
Should be Empty:

Rental Application

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