Application is hereby made to rent premises generally described as _____________________________________________for a term of______and ending
the____day of_____________, 19____, for which monthly rental shall be $__________, payable
in advance, and for which a security deposit of $__________shall be due prior to occupancy of the
above-described premises.
A deposit of $________is made herewith on account of the first month's rent, with the
understanding that if this application is accepted and the applicant fails to execute a lease before the beginning date specified above, or to pay the balance due as first month's rent, said payment will be forfeited as liquidated damages.
It is also understood that if this application is not accepted, or if the premises are not ready for occupancy by the applicant on the date specified above, said deposit shall be refunded to the applicant forthwith, upon applicant's request.
Present Address:__________________________________________How Long?_________
Previous Address:__________________________________________How Long?
Married:__________Spouse's Name:____________________________________
Children?________________How Many?________________Ages?.
Pets?________________What Kind?___________________How Many?
Employer Address:_____________________________________________
Supervisor:____________________________Bus. Phone:
How Long on Present Job?________________________Annual Income:
SPOUSE'S EMPLOYMENT Employer:___________________________________________________
Employer Address:
Supervisor:____________________________Bus. Phone:
How Long on Present Job?___________________Annual Income:
Personal Reference:__________________________Phone:.
Credit Reference:____________________________Phone: _
Credit Reference:____________________________Phone:
The information provided herein may be used by the landlord or his agent to determine whether to accept this application. Upon written request within 30 days, the landlord or his agent will disclose to applicant in writing the nature and scope of any investigation landlord has requested, and will, if this application is refused, state in writing the reason for said refusal.










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