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About this Form: This sample rental application asks the applicant to provide his or her Social Security Number.  It also asks the applicant to provide bank account information. If you would like a form that does not ask applicants for this information, click here.

Equal Housing Opportunity

The undersigned hereby makes an application to rent the following property: ____________________________________________________________________________________.

Anticipated move date of ___________________at a monthly rent of $_______________ and security deposit of $_______________.

Full Name__________________________________________________ Home Phone (        ) ________________________
Date of Birth_________________________________  Social Security #__________________________________________
Email Address:__________________________________________(optional)    Other Phone (       ) ___________________
Co-Applicant Name_________________________________________ Names of Dependents_________________________
Co-Applicant Date of Birth______________________  Social Security #__________________________________________
Dependents Date of Birth________________________________________________________________________________
List All Pets__________________________________________________________________________________________

Current Address_______________________________Apt#________ City__________________ State______ Zip________
Month/Year Moved In______________________ Reasons for Leaving____________________________Rent $__________
Owner/Agent__________________________________________________Phone (       ) ____________________________
Previous Address (last 3 years)_________________________________________________________Rent $____________
Owner/Agent__________________________________________________Phone (       ) ____________________________


Have you declared bankruptcy in the past seven (7) years? Yes___________ No____________
Have you ever been evicted from a rental residence? Yes___________ No____________
Have you had two or more late rental payments in the past year? Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due? Yes___________ No____________

Your Status:  _____Full Time _____Part Time _____Student _____Unemployed
Dates employed_______________________________ Employed as______________________________________________
Supervisor Name______________________________________________ Phone (        )______________________________
Salary $_________________per________________.  (If employed by above less than 12 months, give name & phone of previous employer or school:________________________________________________________________________________.)
If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

Amount $___________________ Source/Contact Name__________________________________________________________

Banking  Accounts:
Name_________________ Type of Account_________________ Account Number_________________
Name_________________ Type of Account_________________ Account Number_________________

Personal Reference or Emergency Contact:
Name _______________________ Address _______________________________________________
Phone _______________________ Relationship_______________________

Driver's License:
Your Driver's License Number_________________ State_________________

Vehicle Information:
Make / Model _________________Year _________________License Plate State_________________


Please give any additional information that might help owner/management evaluate this application?

Where may we reach you to discuss this application?

Day Phone # (         ) ___________________________ Night Phone # (          )____________________________

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.

I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted in 3 business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When so approved and accepted, I agree to execute a lease for ___________ months before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.

Please sign:  X__________________________________     __________________________________
Name of Applicant                                                   Date

Release of Information

I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner/manager.

Name (please print)

X_______________________________________       __________________________
Signature                                                                                 Date


Deposit of $__________________ Received by ____________________________ Date_______________


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