Apply

PLEASE NOTE: A nonrefundable* processing fee of $40.00 must be submitted with this Rental Application. *Refundable only if Landlord chooses to rent to another applicant prior to processing this Application.

Please complete all sections legibly. Separate applications must be submitted by each applicant over 18 (including spouse) who will be residing at these premises.

Property Information

Address to be Rented Apt. #

Personal Information

First Name Middle Name Last Name Maiden/Other Names Used Social Security Number

Date of Birth Email Home Phone Work Phone Cell Phone

Residential Information

Current Address

Address City State Zip Move-in Date

Monthly Payment Rent or Own Given Proper Notice to Vacate? If No, Please Explain

Current Landlord Landlord Address City State Zip

Landlord Phone Reason for Moving

Previous Address

If you have lived at the above address for less than 5 years, please list your previous residence

Address City State Zip Move-in Date

Monthly Payment Rent or Own Given Proper Notice to Vacate? If No, Please Explain

Previous Landlord Landlord Address City State Zip

Landlord Phone Reason for Moving

Employment Information

Current Employer

Employer Name Address City State Zip

Phone Supervisor Date Employed Monthly Gross Pay Job Title/Duties

Previous Employer

Employer Name Address City State Zip

Phone Supervisor Date Employed Monthly Gross Pay Job Title/Duties

Other Occupants

Please list all other applicants that will be living with you

First Name Last Name Social Security Number Phone Relationship

Emergency Contact

Name Address/City/State/Zip Phone Relationship

Vehicles

Vehicle 1

Make/Model Year Color Plate Number State

Vehicle 2

Make/Model Year Color Plate Number State

Description of any other vehicle (car, boat, trailer, rv, etc.) you would like to keep on the premises. Prior written permission separate from this application must be obtained from Landlord.

Additional Information

Military Service

Branch Rank Date Enlisted MOS/Specialty Battalion/Regiment/Company

Monthly Take Home Pay Address of Duty Station Commanding Officer Phone

Do You or Any Listed Above Smoke?

Do You or Any Listed Above Use Illegal Drugs?

Do You Have or Intend To Have Any Pets?

If Yes, What Type?

Do You Have Water Filled Furniture or Aquariums?

Are You or Anyone Listed Above Currently On Parole or Probation Anywhere?

If Yes, Please Explain and Give the Name and Phone Number of Your Officer

Authorization

The undersigned applicant hereby declares that all information provided on this Rental Application is true and correct to the best of his/her knowledge. Applicant hereby authorizes the owner, manager, or his/her agent (hereinafter "Landlord") to verify any information at any time contained in this application, including but not limited to, verification of current residency and employment. Applicant understands that this verification process may include obtaining a tenant performance / credit report from various consumer reporting sources and specifically authorizes the Landlord to obtain such reports as allowed by the Fair Credit Reporting Act. This application is for preliminary screening use only and does not obligate Landlord to execute a rental agreement or deliver possession of the premises. Applicant further acknowledges that any false information contained herein will void this application and terminate any rental agreement. Landlord is also given the right to conduct a criminal and/or background check. Once all information is submitted, it becomes the property of 50th State Management Corporation.

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