Today's Date: _______________________
Application is hereby made to rent premises generally described as:
for a term of _______
and ending the _____ day of ___________, 201(x), 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.
Present Address: ____________________________________ How Long? _______
Previous Address: ___________________________________ How Long? _______
Married: _______ Spouse's Name: ________________________________________
Children? ______________ How Many? _____________ Ages? ______________
Pets? ______________ What Kind? ________________ How Many? __________
Employer Address: ____________________________________________________
Supervisor: _______________________ Bus. Phone: ________________________
How Long on Present Job? __________________ Annual Income: ______________
Supervisor: _____________________ Bus. Phone: __________________________
How Long on Present Job? _______________ Annual Income: _________________
Bank: __________________________________ Phone: _____________________
Personal Reference: ______________________ Phone: _____________________
Credit Reference: _______________________ Phone: ______________________
_______________________ 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 ________