Today's Date: _____________Occupancy Date Desired:__________________            

Rental Price Range: _______________  Dates of Occupancy : ___________________

APPLICANT'S PERSONAL INFORMATION
Last Name:______________________ First:_______________________ Middle:________________      

Driver's License Number: ___________________________            

Email address: _________________________________

Passport #(if not a Filipino)___________________ Issuing Country_____________ Type: _______

Home Phone #___________Work #: _______  Cell phone #:_____________

Additional Occupants (List every occupant name and their relationship below, including children)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

How long do you plan on living in the next rental home that meets your needs? ___________________

Do you have renter's insurance? _______ Do you have any water-filled furniture? _______
Have you ever broken a lease? ____ Have you ever refused to pay rent for any reason? ____  

Have you ever been evicted or asked to leave a rental unit? _______

Ever filed for bankruptcy? _________Ever been convicted of a crime ____

Will you give us permission to do a criminal background check? _____
 

Currently have any utilities in your name? ____

Currently have phone service in your name? _______

Is there anything to prevent you from placing utilities or phone in your name? ___________

Do you know of anything or any reason which may interrupt your ability to pay rent? _____

RESIDENCE HISTORY
Present Street Address _________________________________________ City _______________

Dates lived at this address?_____________________________ Own ____ Rent ____

Current Phone ______________  How many pets do you own? What kind?____________

How long at present address?_________  Leaseholder:___________________________

Name of present landlord/owner/mortgage company:_____________________________
Address of present landlord/mortgage company: ________________________________

Landlord's phone: ________________ Monthly payment: ______________________

Reason for moving:____________________________ Is your rent/mtg current?_______

Number of late payments? ___ Security Deposit Amount currently held by landlord?_____ 
 

Previous Residence Address: ______________________________________________
Previous landlord:_________________ Previous landlord's #:______________

Dates at this address:____________Reason for moving?__________________________

Was your Full Security Dep. Returned?______ # of late payments? ____

Monthly payment? ________

Previous Residence Address: _______________________________________

Previous landlord:___________________ Previous landlord's #:_____________________

Dates at this address:____________ Reason for moving?_________________________
Was your Full Security Dep. Returned?______ # of late payments? ____

Monthly payment? ________ 
                                                                                                                                        

INCOME HISTORY                                                                                                                               

Applicant's current employment status:                                                                                              

Full-time _____ Part-time (less than 32hrs) _____ Student _____ Retired _____ Self-employed _____ Unemployed ______ Other ___________________________________

Primary source of employment:
Employer : ______________________ __Supervisor's name:______________________
Average Weekly hours:_______________ How long with present employer? __________
Address:_______________________________________________________________________

City:__________________________________________ Phone: ________________ Position:_____________________Annual Income: ___________________

Please indicate Weekly, Bi-Weekly, Monthly, or Annual Average Take home:___________________

Additional Employment
Employer:________________________ Supervisor's name:_______________________

Average Weekly hours:_____________How long with present employer? ____________
Address:_______________________________________________________________________  

City:__________________________________________ Phone: ________________ Position:______________________ Annual Income: ___________

Please indicate Weekly, Bi-Weekly, Monthly, or Annual Average Take home:___________________

OR if currently enrolled:

Name of School: _____________________Year_____ Expected Graduation:_________

Program: _____________________________

Address: ________________________ City: ________________

ADDITIONAL INCOME / PAYMENT INFORMATION
In the event of some emergency that would prevent you from paying rent when due, is there a relative, person, or agency that could assist you with rent payments?
1st Emergency Contact: __________________________________________________________
Relationship___________________________________________________________________

Address______________________________________________________________________
Phone#____________________________ 2nd Phone#_________________________

2nd Emergency Contact: _________________________________________________
Relationship __________________________________________________________
Address______________________________________________________________________
Phone# ______________________________ 2nd Phone #_______________________
Do you currently have a savings account, line of credit, or charge card sufficient to cover one month's rent? ______________________________________________________

ADDITIONAL INCOME: (optional)
If there are additional, verifiable sources of income you would like considered, Please list income source (i.e., self-employment, benefit payments, etc.), and requested information below regarding each source. Applicant may be required to produce additional documentation or provide and sign release statements. Child support, alimony, or separate maintenance need NOT be disclosed unless you desire this additional income to be considered for qualification.

Additional Source:________________________________Amount:$_______ Per__________           

Contact person: ____________________________________ Phone:________________________
How long have you been receiving income from this source?____

How long do you expect this income continue?_____________________

Is there any reason it would stop?________________________

Additional Source:________________________________Amount:$_______ Per__________           

Contact person: ______________________________ Phone:____________________
How long have you been receiving income from this source?____

How long do you expect this income continue?_____________________

Is there any reason it would stop?________________________

ASSETS / CREDITS / LOANS
Number of vehicles on property? ____Valid registration & inspection?________________
Do Vehicle 1-make/model/color/year________________________________________
Please note, only cars on application are authorized to be on premises.
Plate number_______________________________________
Financed through __________________________________________________         

Contact and phone number____________________________________________________________               

Acct. # ____________________________ Monthly payment ____________________

Vehicle 2-make/model/color/year___________________________________________
Please note, only cars on application are authorized to be on premises.
Plate number_________________________

Financed through _____________________________________________________________         

Contact and phone number___________________________________________________________              

Acct. # _______________________________________ Monthly payment ____________________

CREDIT CARDS, LOANS (including banks, department store, gas cards, student loans)
Creditor:_________________________________________________________________________
Address___________________________________________________________________________
Phone: _____________________ Acct. #:___________________________________
Total Amount owed:_______ Monthly payment:_____ Are your payments current?______

Other Creditor:________________________________________________________
Address _____________________________________________________________
Phone: _____________________ Acct. #:____________________________________
Total Amount owed:______ Monthly payment:________Are your payments current?_____

                                                                                                                                                             
List any other current monthly expenses?
Hospital payment ____________ Health Insurance _____________ Auto Insurance _____________           

Renter's Insurance ______ Child care ____________ Tuition ___________________
Cable TV __________________ Other _______________________ Amount __________________

BANK REFERENCE                                                                                                                                      

Name of bank and branch:___________________________Phone:________________
Branch address:_______________________________________________________
Checking Acct. #:_______________________________________________________
Savings Acct#:_________________________________________________________
How long account active, (C)_____  (S)_____ Average monthly balance, (C)_________ (S) _________
PERSONAL/PROFESSIONAL REFERENCES
Character/Personal reference:
Name_____________________________________ Time known: _________________
Address___________________________________________________________________________
City ______________________________ Relationship?________________________

How long? ______________ Phone __________________

Professional reference (i.e. attorney, accountant):
Name_________________________________ Time known: ____________________
Address__________________________________________________________________________
City ______________________________________ Relationship?___________________

How long? ________ Phone _________________

Name of Nearest Living Relative:
Name____________________________________________________________________________
Address_____________________________________________________________ City ___________________

Relationship?________________________ How long? ___________ Phone ____________________

Name of Doctor or Health Care Provider:
Name____________________________________________________________________________ Address___________________________________________________________ City ______________________
Relationship?________________________ How long? ______________ Phone _________________

Guarantor Information:

Guarantor Name:________________________________________________________

Date of Birth: ____________________

Relationship to applicant: ______________________Years Known: ________________

Address: ___________________________________City: ______________

Home phone: ___________ Cell phone:_____________Work phone: _______________

Fax: ______________________ Email: ______________________

Employer: ____________________________How long with present employer?_______

Address: ________________________________________________

City_______________________

Position/Title: _____________________ Supervisor : _______________________

Phone: ___________________Annual Income_____________

Do you give owner or manager permission to contact references listed above both now and in the future for rental consideration or for collection purposes should they be deemed necessary?_____________

If Management has a question regarding this application, please furnish the best contact phone number:
Day phone/contact person:________________________________________________
Night phone/contact person:_______________________________________________

THANK YOU!

Thank you for completing an application to rent from us. Please sign below. Please note that a completed application requires submission of the following which will be copied and attached to this application:                                          

__ Driver's License.  Note: rentals will not be shown without picture ID
__ Personal check (to verify bank)  __ 2 weeks of most current pay stubs of each income source listed  

__ If self-employed, most current income tax and proof of current income

A fee of P ________ is charged on all rental applicants for the purpose of verifying the information furnished on this application. By signing below, applicant hereby represents all information on this application is true, complete, and hereby authorizes annual verification of information, references, and credit history for continual rental consideration or for collection purposes should that become necessary. This fee is refundable / nonrefundable / or only refundable if applicant meets our minimal criteria but is not selected because they were not the first qualified applicant.

Applicant acknowledges this application will become part of the lease agreement when approved. If any information is found to be incorrect, the application will be rejected and any subsequent rental agreement becomes void. False and misleading statements will be sufficient reason for immediate eviction and loss of security deposit.

Applicant's signature:________________________________________ Date:________________________