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FORM #1: APPLICATION TO RENT


OWNER/AGENT TO COMPLETE
(required entries are indicated by *)

  • Property Address*:
  • Date received:  Time received   a.m.   p.m.
  •  # of units available (of the type and in the area) that will be available for rent in the near future by this owner.
  •  # of applications previously accepted and remaining under consideration for those units.
  • (If left blank, at least one unit is available and no previously accepted applications currently under consideration have been accepted.)
  • Examined picture identification? Yes   No
  • Type of identification? 

RENT, DEPOSIT & FEE DISCLOSURE

(Amounts listed below may be subject to change before the rental agreement is executed)

  • Monthly Rent: $ Security Deposit: $ Other Deposit: $

DEPOSITS MAY INCREASE IF APPLICANT IS UNABLE TO MEET ONE OR MORE OF OWNER/AGENTS SCREENING CRITERIA.

  •  If checked, Renter’s Insurance is required
    – Tenant is required to maintain minimum of $100,000 liability coverage and list Owner/Agent as Interested Party. If Tenant(s) combined household income falls at or below 50% of the median for the area, Renter’s Insurance may not be required. Owner/Agent is also responsible to maintain their own insurance policy and may not “self insure” if Renter’s Insurance is to be required. Owner/Agent must provide proof of property insurance to Tenant upon request.

Owner/Agent may charge the following:
  • Late payment of rent charge of $
  • Smoke alarm and carbon monoxide alarm tampering fee of $250.
  • Dishonored check fee of $35 plus amount charged by bank.
  • Early termination of lease fee not to exceed 1-1/2 times the monthly rent, or actual damages at the option of Owner/Agent.
  • Owner/Agent may charge the following non-compliance fees after first giving a written warning notice of initial violation if noncompliance occurs within one year: $50 fee for 2nd violation, and $50 plus 5% of current rent for each subsequent violation.
    1. Failure to clean up animal waste, garbage, rubbish or other waste.
    2. Parking violation or other improper use of vehicle.
  • Owner/Agent may charge a fee for keeping on the premises an unauthorized pet capable of causing damage. Fee may be assessed for repeat violations that occur as early as 48 hours after the effective date of written warning notice, and for each subsequent violation within one year of issuance of written warning. Fee not to exceed $250 per violation.
  • Owner/Agent may charge a fee for smoking/vaping in a clearly designated non-smoking/vaping unit or area of the premises. Fee may be assessed for repeat violations that occur as early as 24 hours after the effective date of a written warning notice, and for each subsequent violation within one year of issuance of written warning. Fee not to exceed $250 per violation.

PERSONAL INFORMATION

  • Applicant Name*: Telephone: () -
  • Email Address: Cellular Number: () -
  • S.S. #: Birth Date: Driver’s License State and #:
  1. Current Address: City: State: Zip:
    Since: Why are you moving?
    Current Landlord: Rent Amount: $ Telephone: (-
  2. Previous Address: City: State: Zip:
    From: to  Why did you move?
    Previous Landlord: Telephone: (-
  3. Previous Address: City: State: Zip:
    From: to Why did you move?
    Previous Landlord: Telephone (-
  • Have you ever: Been Evicted? Yes   No   Been sued by Landlord? Yes   No   Filed Bankruptcy? Yes   No
    Been convicted, or plead guilty or no contest, to a crime? Yes   No   
If yes to any of these, please explain:


If your service or companion animal requires a reasonable accommodation please inquire with Owner/Agent.
  1. Animal #1 - Type: Size: Weight: Ever injured anyone or damaged anything? Yes   No
  2. Animal #2 - Type: Size: Weight: Ever injured anyone or damaged anything? Yes   No

OUTSTANDING DEBTS

Please list below all outstanding past due payment obligations and/or collections accounts.

BANK INFORMATION

  1. Bank: Branch: Checking Account #:
  2. Bank: Branch: Savings Account #:
  3. Bank: Branch: Type/Account #:

EMPLOYMENT/INCOME

  1. Current Employer: How Long?
    Supervisor: Telephone: () -
    Job Title: Take home pay (per month): $ Full-time   Part-time
  2. Previous Employer: How Long?
    Supervisor: Telephone: () -
    Job Title: Take home pay (per month): $ Full-time   Part-time
  • Other Income (per month): $ Source: Telephone: () -
  • Other Income (per month): $ Source: Telephone: () -

REFERENCES

  1. Relative: Telephone: (-
  2. Emergency Contact:  Telephone: (-
  3. Personal Reference: Telephone: (-

PERSONAL PROPERTY

  1. Automobile: Make Model Year License # State
  2. Automobile: Make Model Year License # State
  3. Other:Vehicles/Boats Model Year License # State
Do you own the following:
Trampoline? Yes   No             Water-filled furniture? Yes   No             Fish Tank or Aquarium? Yes   No

MEMBERS OF HOUSEHOLD

For purposes of identification only, please list names and either ages or dates of birth of other persons to occupy unit:


APPLICANT SCREENING CHARGE DISCLOSURES

  1. Owner/Agent may obtain a credit report, or a tenant screening report which generally consists of:
    • a) Credit history including credit report;
    • b) Public records, including but not limited to judgments, liens, evictions and status of collection accounts;
    • c) Current obligations and credit ratings; and/or
    • d) Criminal records or other information verification.
  2. Owner/Agent is requiring payment of an Applicant Screening Charge $ none of which is refundable unless the Owner/Agent does not screen the applicant. This application is valid for up to 30 days from date of receipt by Owner/Agent.
  3. Any charges imposed upon Owner/Agent by a Homeowner’s or Condominium Association for anyone who moves into or out of a unit within the association, may be passed through to the Tenant(s) for payment as allowed by law. Current fee is $
  4. If the mail receptacle associated with the dwelling unit is a locking type, Tenant(s) are solely responsible for the fees charged by the Postmaster for the re-keying of the box should a key not be provided by the Owner/Agent, or if the mail box has not been re-keyed between tenancies.

Incomplete applications will not be accepted. Inability to verify information may result in denial of application. Presentation of false information may result in denial of application or termination of tenancy if discovered within one year of submission of application.

I certify the above information is correct and complete and hereby authorize the Owner/Agent to make any inquiries the Owner/Agent feels necessary to evaluate my tenancy and credit standing (including, but not limited to credit reports). If Owner/Agent is requiring payment of an applicant screening charge, I acknowledge receiving a copy of and/or reading Owner/Agent’s Screening Guidelines. I understand that I have the right to dispute the accuracy of any information provided to the Owner/Agent by a screening service or credit reporting agency.

No marijuana, medical or otherwise, may be grown, stored or consumed on the premises without the prior written consent of Owner/Agent.

_________________________________________
ApplicantDate

     

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