Rental Application

PLEASE NOTE: A separate application is required for each applicant over the age of
18 (excluding dependent children) who will reside at the property. This is to guarantee
compliance with the state and Federal Fair Housing Acts. Please print clearly and
complete all sections. Incomplete applications will not be processed. Certain animals
including Pit Bulls, Rotweilers, and any animal with a history of biting are not accepted.
Please Print or Type
Address of rental property: ______________________________________________________________________________
Todays date: ____/____/____ Desired move in date: ____/____/____

Desired length of occupancy? _______ Years

Applicant's full legal name__________________________________________ Soc Sec #_________/_______/___________

Drivers License Number: _______________________________________________________ State: __________________
Date of birth ____/____/____ Birthplace: _________________________Mothers Maiden Name:______________________
Other name(s) used within the last 3 yrs.____________________________________________________________________
Home phone #____________________ Work phone #_______________________ Cell phone #______________________
Email address___________________________________________
List Your Last Four Years Residence History & At Least Your Last Two Addresses
Current address________________________________________________________ City__________________________
State____ Zip____________

Type of property? ( 2 bedroom apartment, house, etc.) ______________________________

How long at present address?__________ Occupancy dates______________________ Current Rent/Payment $__________

Landlord or Mortgage Company?________________________________________ Phone #__________________________
Loan # (if applicable)_____________________________________ Are Your Payments Current? Yes______

No ______

Why are you moving?__________________________________________________________________________________

Former address: _________________________________________ City___________________________ State_______
Zip____________

Type of property? ____________________________________________________________________

How long at former address?___________ Occupancy dates________________ Why moved?________________________

Former Landlord's Name________________________________________ Phone :_________________________________
List Your Employment History For The Last Four Years (Please include titles or military ranks, etc. Note - you may be asked to
substantiate your income with tax returns and/or other documentation if self employed.)
Current Employer________________________________ How Long?_______________ Phone #___________________
Address____________________________________ City__________________________ State_______ Zip____________
Position / Job description____________________________________________________ Monthly gross pay $___________
Monthly take-home $___________ Superior's Name/Position______________________________ Phone #_____________
Former Employer________________________________ How Long?_______________ Phone #___________________
Position / Job description____________________________________________________ Monthly gross pay $___________
Monthly take-home $___________ Superior's Name/Position______________________________ Phone #_____________
List any additional monthly income (child support, SS, etc.) _________________________________________________
List others who will be living with you:
Name

Relationship

Age

Occupation

1.___________________________________________________________________________________________________
2.___________________________________________________________________________________________________
3.___________________________________________________________________________________________________
4.___________________________________________________________________________________________________

List Nearest Relatives (for Emergency Contact and/or Reference)

Name

Relationship

Address

Phone

1.___________________________________________________________________________________________________
2.___________________________________________________________________________________________________
List All Vehicles:
#1 Year ______ Model ___________ # 2 Year ____ Model ________ # 3 Year_____ Model __________
License No./State _________/____

__________/____

__________/____

List All Pets Which You Desire To Have Live On The Premises
Pets Name

Type/Breed/Weight

Sex/Neutered/Spayed

1.__________________________________________________________________________________________________
2.___________________________________________________________________________________________________
3.___________________________________________________________________________________________________
List Bank Accounts
Bank Name

Account #

Checking/Savings

Approx. Balance

1.___________________________________________________________________________________________________
2.___________________________________________________________________________________________________
Credit References - Credit Cards & Loans What are your approximate scheduled monthly payments?
Owed To

Balance

Monthly Payment

1.__________________________________________________________________________________________________
2.___________________________________________________________________________________________________
3.___________________________________________________________________________________________________
List Two Personal References (Not related to you)
Name

City/State

Phone #

1.___________________________________________________________________________________________________
2.___________________________________________________________________________________________________
Learned Skills: ( ) Painting ( ) Carpentry ( ) Plumbing ( ) Other: _____________________________________________

Please answer all questions

1. Have you ever been evicted? ( ) Yes ( ) No When : ___________________________________
2. Have you ever willfully and intentionally refused to pay rent when due? ( ) Yes ( ) No
3. Do you know of anything which might interrupt your income or ability to pay rent? ( ) Yes ( ) No
5. Rent is due in advance on the first of each month. Are you able to fulfill this requirement ( ) Yes ( ) No
6. Have you ever filed a petition of bankruptcy? ( ) Yes ( ) No When was it discharged? _____________
7. Have you or anyone in your household ever been convicted of a felony or misdemeanor? ( ) Yes ( ) No
8. Are you obligated to pay child support or alimony? ( ) Yes ( ) No Amount $______________
9. Do you plan to conduct any business in the house? ( ) Yes ( ) No If yes, what type of business? _________
APPLICANT AGREES TO PAY AN APPLICATION FEE OF $100.00 FOR THE PROCESSING OF THIS RENTAL APPLICATION. $50
of this fee will be refunded in the event that the tenant is not approved. If the tenant is approved, the entire $100 will be applied toward the
deposit on the property. After approval, no refunds are possible. Please make checks payable to VMI, Inc. Landlord and his agents are
hereby authorized to obtain credit reports, and criminal history on applicant using various state and private sources along with other public
records available. Applicant understands and agrees that applicant will not receive copies of any credit reports obtained. Applicant
authorizes present and past Landlords, Employers, Banks, Credit References, Personal References and any other person to release
information regarding applicant's credit, rental, employment and/or criminal histories. A copy of this authorization may be accepted as an
original.
Signing this acknowledgement indicates that you have had the opportunity to review the landlords tenant selection criteria. The tenant selection
criteria may include factors such as criminal history, credit history, current income and rental history. If you do not meet the selection criteria, or
if you provide inaccurate or incomplete information, your application may be rejected, and your application fee will not be refunded.

Applicant's Signature: ___________________________________________

Date ___/___/___