Application is hereby made to rent premises generally described as _________________________ for a term of ___ and ending the __ day of ________, 20 __, 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: _________
Employer Address: ___________________________
Supervisor: __________________ Bus. Phone: __________________
How Long on Present Job? _______________ Annual Income: _____________
Bank: ___________________ Phone: __________________
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.
Accepted ________ Refused ________
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