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RESIDENTIAL LEASE APPLICATION
Rental Address: ______________________________________________ Date of Application: ____/____/____
Name: ___________________________________________________ Desired Move-in Date: ____/____/____
Phone: _______________________________ Email: ______________________________________________
Social security #: _______________________________ Date of birth: _____/_____/_____
Driver’s license #: ______________________________ State of issuance: _____________
Marital status: _________________________________ Spouse name: ________________________________
Children names: ____________________________________________________________________________
Emergency contact: ______________________________ Phone: _____________________________________
Personal reference: _______________________________ Relationship: ___________ Phone: _____________
Length of time you intend to reside at rental: _____________________________________________________
Occupants other than children: _______________________________________________________________
Describe any pets that will occupy the residence: ________________________________________________
Has the pet(s) ever injured anyone or damaged anything? ☐ Yes ☐ No
Note: Please verify that pets comply with the pet policy associated with this residence.
Job title: ____________________________ Employer: _____________________________________________
Employer’s address: _________________________________________________________________________
Supervisor: ______________________________________ Phone: ___________________________________
Monthly pay: $________________________ Start date: _____/_____/_____ ☐ Full time ☐ Part time
Other income (per month): $_____________ Source: ___________________ Phone: _____________________
Have you ever: Been evicted? ☐ Yes ☐ No; Been sued by Landlord? ☐ Yes ☐ No; Been convicted, or pleaded
guilty or no contest, to a crime? ☐ Yes ☐ No; Filed bankruptcy? ☐ Yes ☐ No; If yes to any of these, please
explain: ___________________________________________________________________________________
Bank name: __________________________________________ Phone: _______________________________
Account #: ______________________ Account #: _____________________ Note: Last four digits acceptable.
Credit card type: ___________ Card #: ___________ Credit card type: ___________ Card #: ___________
Credit card type: ___________ Card #: ___________ Credit card type: ___________ Card #: ___________
Creditors: Type of debt: Amount owed: Monthly payment:
____________________ ____________________ ____________________ ____________________
____________________ ____________________ ____________________ ____________________
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For Landlord’s use only:
Date received: ____/____/____ Time received: ____________AM/PM Initial: ____________________
Rent: $ ___________________ Deposit: $ __________________
Picture ID examined: ☐ Yes ☐ No, Identification type: ☐ Driver’s license ☐
Other: ___________
Application fee received: ☐ Yes ☐ No, Payment type: ☐ Cash ☐
Money Order Amount: $_______
Income verification provided: ☐ Yes ☐ No
Sent to consulting company: ☐ Yes ☐ No, Date: ____/____/____ Initial: _______________________