Applicants full name ___________________________________Phone #___________________DOB__________
Previous
Names/Maiden Name___________________________________________________________________
Social Security #____________________Drivers
License #____________________State________Exp.________
Current Address________________________________City___________________State________Zip_________
Current
Landlords Name __________________________________Landlords Phone #______________________
Current Rent__________________
Rent Paid Through _________________ Current Lease Expires___________
How long at this address __________Reason for leaving______________________________________________
Previous
Address________________________________City___________________State_______Zip_________
Previous Landlords Name __________________________________________Phone
#______________________
How long at this address __________Reason for leaving______________________________________________
Auto
Yr ______Make ____________Model _____________________State/License Plate #___________________
Present Employer_____________________________Position__________________Mo.
Income______________
Name of Supervisor_________________________________
Phone #__________________How long at
job _________Other income/source____________________________
Employers Address_________________________________________City___________________State________
Have
you ever been evicted? [ ] Yes [ ] No Have you ever filed for Bankruptcy? [ ] Yes [ ] No
Have you ever willfully and
intentionally refused to pay any rent when due? [ ] Yes [ ] No
Name of bank _________________________Branch _____________________Type
of Account_______________
Name of bank _________________________Branch _____________________Type of Account_______________
Personal
References
Name ______________________________Yrs. Known ____Relationship ____________Phone #______________
Name
______________________________Yrs. Known ____Relationship ____________Phone #______________
Total number of adults ___________Total
number of children living with you under the age of 18_____________
Names and relations of all other applicants_________________________________________________________
___________________________________________________________________________________________
I
CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements
contained in this application for tenant screening and authorize the obtaining of a Consumer Credit Report, I understand that
the landlord may terminate any rental agreement entered into for any misrepresentations made above.
Signature________________________________________________________________Date________________
Received
from applicant the non-refundable sum of $____dollars for tenant screening.
