Please note there is a $25 fee for each applicant.

                                           RESIDENTIAL RENTAL APPLICATION


Name of Applicant(s)________________________________________________________

__________________________________________________________________________

Telephone_________________________________________________________________

__________________________________________________________________________

Current Address(es)________________________________________________________________

__________________________________________________________________________


City, State, Zip Code______________________________________________________________________

Social Security Number(s)_________________________________________________________________

__________________________________________________________________________

Drivers License Number(s)_________________________________________________________________

Birth date(s)____________________________________________________________________

Who will be occupying the home? Adults_________________ Children_______________

How long have you lived at your current address?________________________________

Name of Landlord____________________________________Telephone_____________________

Previous Landlord____________________________________Telephone_____________________




 

Please complete for each individual who will be named in the lease agreement and responsible for paying rent:

Employer____________________________________Position_______________________

How long? __________________________________Telephone_____________________

Salary – Pay Rate and Hours Worked___________________________________________________________________

Employer____________________________________Position_______________________

How long?_______________________________________Telephone_____________________

Salary – Pay Rate and Hours Worked___________________________________________________________________

Additional Personal/Credit References

Name - Relationship – Telephone Number (no relatives please)

_________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

I represent that the information provided in this application is true to the best of
my knowledge. You are hereby authorized to verify my credit and employment references in connection with the processing of this application. I acknowledge receipt of a copy of this application.


__________________________________________________________________________
Signed                                                          Print Name                                Date


__________________________________________________________________________
Signed                                                          Print Name                                Date

 

Fax to Shelley Stults at 800-667-1422

Phone: 800-667-3070 or  516-429-6086 Cell