Rental Application

All fields marked with a red * are required.

Applicant’s Information

First Name

Middle Name

Last Name

Home or Mobile Phone

Work Phone

Date of Birth (mm/dd/yyyy

Social Security #

Driver’s License or ID #

Maiden Name / AKA

Additional Tenants or Guests

List the name and relationship of every person who will live with you, even if only temporarily.

Full Name

Relationship

Full Name

Relationship

Applicant’s Rental History

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

From

Rent Amount

Landlord

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

From

Rent Amount

Landlord

Employment History

Present Employer / Occupation

Employer

Position

Hire Date

Wage/Salary/Income

How Long?

Supervisor

Phone Number

Previous Employer / Occupation

Employer

Address

How Long?

Supervisor

Phone Number

Income

Gross income per month from employment

Additional sources and amount of income

Financial Information

Bank Name

Checking?

Yes

Savings?

Yes

Vehicles

Make

Model

Year

License Plate

Make

Model

Year

License Plate

Personal Reference

Must be non-family members.

Name

Address

Phone Number

Name

Address

Phone Number

Name

Address

Phone Number

Emergency Contact

Name

Address

Phone Number

Other Information

Agreement

I state the above information to be true and correct. Any falsified information voids my application. I authorize any Federal, State, or local agency or business and/or its representative to release to Landlord Protection Service any information or materials needed to verify this application. I give my consent to inquire into my credit history, criminal background (county and state), rental history, and any other means necessary to verify my eligibility for rental housing. I agree that a photocopy of this original application may be used for the purposes stated above.

Is there any other Information you would like to provide?

Signature

Sign Here

Printed Name

Date