FAS Rental Verification

Rental Verification Request
Fred A. Smith Company

730 24th St, NW Washington, DC 20037
Applicant's Name:*

First NameLast Name
Applicant's Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Landlord's Name:*
Landlord's Telephone:*

Area CodePhone Number
Landlord's Email:*
example@example.com
Applicant's Prior Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Prior Landlord's Name:*
Landlord's Telephone:*

Area CodePhone Number
Landlord's Email:*
example@example.com
Notice: Read Carefully

The Fair Credit Reporting Act requires that no investigative report be made on any consumer unless he/she has given written approval that such a report may be or has been requested, and he/she is informed that he/she has the right to ask for disclosure of the type of information being sought. As part of our application procedure, Fred A. Smith Company may make inquiries that can provide pertinent information concerning applicant’s character, mode of living, and general tenantability. All information gathered as part of our tenant screening process is held in strict confidence.

I hereby give permission to Fred A. Smith Company to contact any credit bureau for credit information, as well as any reference listed on the application, including my past, current, or future employer, without further notice to the applicant.
Applicant's Signature: *

Clear
Date:*

MonthDayYear
Date
*For Office Use Only*

We have received a rental application from the above named person, to which we understand you rent or have rented. In addition to verifying the information requested below, please furnish us with any other information that might assist us in processing their application. Thank you.

Rental Dates:

From:_______________ To:_________________

Amount of Monthly Rent:__________________

Is account in arrears? Yes / No

Amount owed: $_______________

# of late payments:_________________

Did tenant provide proper notice? Yes / No

Have there been any nuisance complaints filed against the tenant? Yes / No

If yes, please explain:_______________________________________________

Have there been any lease violations: Yes / No

Would you rent to the applicant again? Yes / No

Additional information:______________________________________________

Person completing this form:_________________________________________

Signature:___________________

Date:______________________
Should be Empty:

Rental Verification Request