Online Rental Application Form

Online Rental Application Form

**Each Adult 18 and older must submit an application**
How many bedrooms are you looking for?
If known, what address are you interested in?
Are you looking to move to Kenosha or Racine?
Full Name

First NameLast Name
Middle Name
Middle Name
Other names used or Maiden Name
Date of Birth

MonthDayYear
Date
E-mail
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
- Current Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Landlord Name
  
  First NameLast Name
- Landlord Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Landlord Fax (If Applicable)
  Please enter a valid phone number.Format: (000) 000-0000.
- Landlords Email (If applicable)
  example@example.com
- Date Moved in Current Residence
  
  MonthDayYear
  Date
- When do you want to move in?
  
  MonthDayYear
  Date
- Why are you moving?
- Have you given your current landlord notice of intent to move?
- Current Monthly Rent/Mortgage per mo.
- Do you pay for utilities?
- If yes, what utilities do you pay?
- How many people would be living with you?
- Other Occupants First and Last Name
  
  First NameLast Name
- Other Occupants Date of Birth
  
  MonthDayYear
  Date
- Relationship to other occupant
- Other Occupant First and Last Name
  
  First NameLast Name
- Other Occupant Date of Birth
  
  MonthDayYear
  Date
- Relationship to Other Occupant
- Other Occupant date of birth
  
  MonthDayYear
  Date
- Other Occupant First and Last Name
  
  First NameLast Name
- Other Occupant date of birth
  
  MonthDayYear
  Date
- Relationship to Other Occupants if Applicable
- Address of Previous Residence
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Date Moved In
  
  MonthDayYear
  Date
- Date Moved Out
  
  MonthDayYear
  Date
- Reason for moving
- Previous Landlord Name (Must Include)
  
  First NameLast Name
- Previous Landlord Phone Number (Must Include)
  Please enter a valid phone number.Format: (000) 000-0000.
- Previous Landlord Fax (If applicable)
  Please enter a valid phone number.Format: (000) 000-0000.
- Previous landlords email if applicable
  example@example.com
- Previous Rent Amount Per month
- Did you pay utilities?
- If yes, what utilities did you pay?
- Reason for Moving
- Additional Rental History (If not applicable) please indicate)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Additional Landlord Reference
  
  First NameLast Name
- Additional Landlord Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Previous Rent Amount
- Reason for Moving
- Did you pay utilities?
- If yes, what utilities did you pay for?
- EMPLOYMENT
- Are you currently employed?
- How long have you been on your current job? Must indicate number in years or months
- Hire Date
  
  MonthDayYear
  Date
- Current Employer
- Current Supervisor Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Total Monthly Income
- Current Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Job Title
- Proof of Income
  
  Cancelof
- Previous Employer
- Start Date
  
  MonthDayYear
  Date
- End Date
  
  MonthDayYear
  Date
- Previous Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Length of Employment at Previous Employer
- Job Title at Previous Employer
- Previous Supervisor Name
- Supervisor Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Other Sources of Income. Please include amount. (Housing voucher, SSI, disability, self employed, ect...)
- OTHER
- Do you own furniture?
- Have you ever had a history of bed bugs, roaches, mice, other bug issues?
- Automobiles and Other Vehicles (Make, type, year and color, Lic. No)
- How much do you have at hand now to secure the property? (USD)
- Do you have pets?
- Please describe all pets (Breed, weight, pounds)
- Have you ever been evicted?
- If yes, please explain
- If yes please explain
- Have you ever declared bankruptcy?
- Do you Smoke?
- If you answered yes to any of these questions, please explain:
- Valid ID
  
  Cancelof
- Personal References
  
  First NameLast Name
- Years known and relationship
- Personal Reference Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Personal Reference #2
  
  First NameLast Name
- Personal Reference Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Years Known and Relationship
- How did you hear about JR Properties?
- Emergency Contact
  
  First NameLast Name
- Relationship to Emergency Contact
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- NOTICE: You may obtain information about sex offender registry and persons registered with the registry by contacting the Wisconsin Department of Corrections on the Internet at http://offender.doc.state.wi.us/public/or by phone at 877-234-0085.
  
  The rental of this property is limited to the use and occupancy by the individuals listed above without any right to sublet any or all of the property. Tenant may request in writing within seven days after delivery of the rental unit a list of physical damages or defects, if any, charged to the previous tenants security deposit.
  
  I understand that if I have misrepresented any information on this application that my application will be denied.
  
  I authorize Landlord to do the following (1) contact any indviduals or businesses listed above and verify all of the information provided is in this application before, during, and or after my tenancy.
  
  I acknowledge being furnished copies of the Rental Agreement, Rules & Regulations, and if applicable, any Nonstandard Rental Provisiion. I agree to sign the Rental Agreement, Rules & Regulations and Nonstandard Rental Provisions, if applicable, prior to taking occupancy of the unit.
  
  I certify that all of the information provided in this application is true and accurate to the best of my knowledge.
  
  Note: A security deposit is required from every tenant against damage or loss to the premesis and security deposit CANNOT be used for the last months rent.
- Confirm
- Signature
- Date
  
  MonthDayYear
  Date
- Please verify that you are human
- Should be Empty: