Approved:

Move In Date:

Disqualified
Reason:

2117 FALLS AVE. WATERLOO, IA 50701

(319)236-1136

1) Your Gross monthly income MUST be 2x or more of the monthly rent.

2) Applicants MUST be employed or have a RELIABLE source of income and be able to prove it.
3) Applicants MUST have good references concerning rental payments, housekeeping &
property maintenance form all previous landlords.

Property Applying For:

Date:

FULL NAME

PHONE (

DATE OF BIRTH

SOCIAL SECURITY NUMBER

COAPPLICANT

PHONE (

DATE OF BIRTH

SOCIAL SECURITY NUMBER

CHILDREN: List full names and ages:

,
OTHER OCCUPANTS AND THEIR RELATIONSHIP (Unrelated adults must fill out a separate Rental
Application)
DO YOU HAVE PETS? IF SO, WHAT KIND?

RENTAL HISTORY
CURRENT ADDRESS:
Move in date
Reason for leaving:

CITY
Manager

STATE
Phone

ZIP

Monthly rent

PREVIOUS ADDRESS:
Move in date
Reason for leaving:

CITY
Manager

STATE
Phone

ZIP

Monthly rent

STATE
Phone

ZIP

Monthly rent

CITY
Manager

PREVIOUS ADDRESS:
Move in date
Reason for leaving:

EMPLOYMENT INFORMATION
STATUS:

Full-Time

Part-Time

Student

CURRENT EMPLOYER:

Unemployed

Position:

Address: ________________________________________Dates employed:

Supervisor:

Supervisors phone:

Gross Monthly Income: $

Number of hours per week average:

ANY OTHER SOURCES OF INCOME:

Type:

_________ Amount:

Are you on Section 8?

Verification:

If so, who is your worker?

YOUR BANK:

TYPE OF ACCOUNT:

VEHICLE INFORMATION:
Make/Model

Year

Color

License Plate #

Have you or your spouse/co-applicant ever:

Been evicted or asked to move? Yes ____ No ____
Broken a rental agreement or lease? Yes ____ No ____
Been convicted of a felony or misdemeanor? Yes ____ No ____
Are currently on or scheduled to be on a sex offender registry? Yes

No

If you answered yes to any of the above please give a detailed explanation below:

EMERGENCY CONTACT: (please list your nearest relative not living with you)
Name

Relationship

Address

City

YOUR DAYTIME PHONE:

State

Zip

EVENING PHONE:

I hereby apply to lease the above described premises for the terms and upon the conditions set forth and agree that the rent is to be payable the first
day of each month, in advance. I warrant that all statements above set forth are true; however, should any statement made above be a
misrepresentation or not a true statement of facts, a portion of the deposit will be retained to offset the Landlords time, cost and effort in processing
my application.
Upon acceptance of this application, a deposit shall be retained as part or all of the security deposit. When so approved and accepted, I agree toexecute
a lease for ______ months. Any balance of the security deposit and first months rent shall be due on or before the day I take possession of the apartment.
After this application has been so approved and accepted, should I fail to execute a lease and fail to move in, I understand that this
deposit shall be applied to the Landlords cost, time, effort, lost rent, advertising, etc. and will not be refunded to me.
I hereby authorize the landlord, in processing this application, to check and verify the following:
1.
2.
3.
4.

Employer, position, wages, and any other sources of income.

Previous landlords references.
Court records check, criminal background.
Other references as deemed pertinent to this application.

By signing below, I hereby authorize the release of the information on this application in compliance with any city ordinance.

Signature of Applicant

Date

Signature of Applicant

Date

Deposit $

Received by

Date