EmailMe Form - Rental Application

About You

Make sure information is complete about you and anyone you plan to be living with.

Name *

First Middle Last

Email *

Date of Birth *

MM / DD / YYYY

Relationship Status *

Best Phone Number to Reach You *

### - ### - ####

Others who will be living with you. *

Please list names, ages and relationships of anyone that will be living with you.

Will any of these people be sharing the rent payment with you? If so who?

Driver's License State and Number *

List all vehicles that you and anyone living with you will have. *

List Make, Model, Year and Licence Plate #.

Have you ever been convicted of a crime? *

Yes

No

If you answered yes, please explain here.

Current and Previous Rental History

Please fill out completely so we are able to check your references.

Current Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Current Manager / Landlord *

Current Manager / Landlord's phone # *

### - ### - ####

How long have you lived here and what is the reason for leaving your current residence. *

Amount of current Rent per month *

Other previous managers or landlords and their phone numbers.

Please list names and contact phone number from places you've rented over the last 5 years.

Current and Previous Employment

Current company name, Supervisor's Name and their phone number: *

Enter the person who can verify your income and employment status.

My current monthly salary or wage is: *

Enter your average monthly take home pay.

Enter your previous places of employment, supervisor's name and phone numbers for jobs you've had over the last 5 years.

Credit History

Don't enter credit card numbers, but your average monthly payments are important.

Credit Card 1:
(Enter n/a if you don't use credit cards) *

Enter name of card (visa/MC/other), total balance and monthly payment.

Credit Card 2:

Enter name of card (visa/MC/other), total balance and monthly payment.

Other Credit or Monthly Payments? Include other credit cards, car payments, student loans, etc.
(Enter n/a if you have no other payments.) *

Enter type of debt and monthly payment.

Are you on or will be using public assistance for partial or complete payment of rent? *

Yes

No

Have you ever been taken to collections, filed for financial protection, Chapter 11, Bankruptcy? *

Yes

No

Have you ever been evicted or locked out of your residence by your Landlord or had your belongings moved out by the Sheriff? *

Yes

No

If you've answered yes to the previous questions, use this space to explain or give relevant information.

References

Personal Reference #1: *

Enter a personal reference other than family. Include their phone number and/or email address.

Personal Reference #2: *

Enter a personal reference (family member okay.) Include their phone number and/or email address.

Authorization

I authorize the management to contact any of the above listed people, businesses, neighbors, credit bureaus, background check agencies for the purpose of verifying accuracy of this application. *

I authorize this.

I do not authorize this.

I acknowledge that everything stated in this application is true to the best of my knowledge and I understand Landlord can disqualify my application if anything within this application is found to be false or inaccurate. *

I agree with this.

I do not agree with this.

By checking this box, I validate this as my signature on the date of this application and agree to sign a hard copy of this application at a later date if needed. *

Signature check as my own