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Application To Rent

Spouse Information

Names of Other Occupants and Dates of Birth

Automobiles: Year, Make, Model, License Plate Number

Any additional information you would like to provide?

Current Address:

Do you own o rent your current address?

If Rent, please provide the following information (If less than two years at current address, complete prior landlord information)

Personal References

Have you ever filed for bankrupcy?
Have you ever refused to pay rent when due?
Are you a user of an illegal controlled substance?
Have you ever been evicted or been the subject of an eviction notice?
Have you ever been convicted of a misdemeanor or felony?
Have you ever been involved in the manufacture or distribution of a controlled substance?

Thank you for your submission.

Applicant represents that all the above statements are true and correct and hereby authorizes verification of the above items including, but not limited to, the obtaining of a credit report and agrees to furnish additional credit references upon request. Applicant consents to allow Owner/Agent to disclose tenancy information to previous or subsequent Landlord(s) Applicant further agrees that Owner/Agent may terminate any lease or rental agreement entered into in reliance on any misrepresentation made above.

Owner/Agent will require a non-refundable credit report fee of $___________________ (or not exceed any amount set by law) which must be submitted with this application.

It is further understood that other application may be pending or in the process of being approved on the property that you are applying for.

If a decision to deny your application is based partly or entirely on negative information from a credit report, Owner shall give you a written notice (e.g. PRDS Form RNDR) stating: 1) that the decision was based partly or entirely on information in the credit report; 2) the name, address, and telephone number of the credit reporting agency; and 3) that you have the right to obtain a free copy of the credit report from the credit reporting agency and to dispute the accuracy or completeness of information contained therein.

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