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

Personal Information

Residential Information

Current Address

Previous Address

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

Employment Information

Current Employer

Previous Employer

Other Occupants

Please list all other applicants that will be living with you

Emergency Contact


Vehicle 1

Vehicle 2

Additional Information

Military Service


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.