RENTAL APPLICATION

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 _________