Date: __________________
Application is hereby made to rent premises generally described as ___________________________________________________ for a term of _______ and ending the ____ day of _____________, 20____, for which monthly rental shall be $____________, payable in advance, and for which a security deposit of $_____________ shall be due prior to occupancy of the above-described premises.
A deposit of $________ is made herewith on account of the first month's rent, with the understanding that if this application is accepted and the applicant fails to execute a lease before the beginning date specified above, or to pay the balance due as first month's rent, said payment will be forfeited as liquidated damages.
It is also understood that if this application is not accepted, or if the premises are not ready for occupancy by the applicant on the date specified above, said deposit shall be refunded to the applicant forthwith, upon applicant's request.
APPLICANT
Name: __________________________________________________________________________
Present Address: ____________________________________________ How Long? ___________
Previous Address: ___________________________________________ How Long? ___________
Married: ________ Spouse's Name: __________________________________________________
Children? ______________ How Many? _______________ Ages? _____________________
Pets? _______________ What Kind? ___________________ How Many? ___________
YOUR EMPLOYMENT
Employer: _____________________________________________________________________
Employer Address: ______________________________________________________________
Supervisor: _____________________________ Bus. Phone: _____________________________
How Long on Present Job? _________________________ Annual Income: _________________
SPOUSE'S EMPLOYMENT
Employer: ______________________________________________________________________
Employer Address: _______________________________________________________________
Supervisor: ______________________________ Bus. Phone: _____________________________
How Long on Present Job? ____________________ Annual Income: ______________________
REFERENCES
Bank: ________________________________________ Phone: ___________________________
Personal Reference: _____________________________ Phone: ___________________________
Credit Reference: _______________________________ Phone: ____________________________
Credit Reference: _______________________________ Phone: ____________________________
____________________________ The information provided herein may be used by the landlord or his agent to determine whether to accept this application. Upon written request within 30 days, the landlord or his agent will disclose to applicant in writing the nature and scope of any investigation landlord has requested, and will, if this application is refused, state in writing the reason for said refusal.
Accepted ________ Refused _________