Received on _______________ (date) at _______________ (time)
RESIDENTIAL LEASE APPLICATION
Each occupant and co-applicant 18 years or older must submit a separate application.
Property Address:_______________________________________________________
Anticipated: Move-in Date: _________ Monthly Rent: $ _____ Security Deposit: $ ______
Applicant was referred to Landlord by:
_____Newspaper _____ Sign ______Internet ______ Other ________________________
Applicant’s name (first, middle, last)____________________________________________________________
Is there a co-applicant? __Yes ___ No if yes, co-applicant must submit a separate application.
E-mail:_________ Home Phone _____ Work Phone:________
Mobile/Pager _______
Soc. Sec. No. _____________ Driver License No.____________ in _________ (state)
Date of Birth ______________ Height __________ Weight _________ Eye Color ______
Hair Color_________Marital Status __________ Citizenship _____________ (country)
Emergency Contact: Name:_______________________________________________________
Address:______________________________________ Phone: _________________________
E-mail: _________________________________________________
Name all other persons who will occupy the Property:
Name: ___________________________________ Relationship: _______________ Age:________
Name: ___________________________________ Relationship: _______________ Age:________
Name: ___________________________________ Relationship: _______________ Age:________
Name: ___________________________________ Relationship: _______________ Age:________
Applicant’s Current Address:_________________________________________________
(city, state, zip)__________________________________________________________________
Landlords Name: _______________________________ Email: __________________
Phone:Day: ________________ Night_______________________Cell:____________________
Fax:____________________
Date Moved-In _______________ Move-Out Date __________ Rent $ ___________________
Reason for move:___________________________________________________________________
Applicant’s Previous Address:________________________________________________
(city, state, zip)______________________________________________________________________
Landlords Name: _______________________________ Email: __________________
Phone:Day: ________________ Night_______________________Cell:____________________
Fax:____________________
Date Moved-In _______________ Move-Out Date __________ Rent $ ___________________
Reason for move:___________________________________________________________________
Applicants Current:Employer:____________________________________________________
Address:_____________________________________________________________________
(street, city’, state, zip)__________________________________________________________
Supervisor’s Name:________________________________
Phone: _______________________ Fax: __________________E-mail:_______________
Start Date: Gross Monthly Income: $ ____________________ Position: _________________
Note: If Applicant is self-employed. Landlord may require one or more previous year’s tax return attested by a CPA, attorney, or other tax professional,
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