
PLEASE PRINT       REV 9.1 
 
RENTAL APPLICATION 
•  Each adult (18 or older) must fill out a separate application 
•  There is a non-refundable fee of $20/adult to apply 
 
First                         Middle                         Last  Birth Date  Social Security #  Driver’s License # 
    
Any Other Names You’ve Used In The Past  Home Phone  Cell Phone 
   
All Other Proposed Occupants  Birth Date  Relationship To Applicant 
   
   
   
   
   
 
RENTAL/RESIDENCE HISTORY 
  Current Residence  Previous Residence  Prior Residence 
Street Address 
   
City 
   
State & Zip 
   
Last Rent Amount Paid 
   
Owner/Manager 
   
and Phone Number 
   
Reason for leaving 
 
 
  
Is/Was rent paid in full? 
   
Did you give notice? 
   
Were you asked to 
move? 
   
Name(s) in which your 
utilities are now billed: 
 
  From/To  From/To  From/To 
Dates of Residency 
   
 
EMPLOYMENT HISTORY 
  Current Employment  Previous Employment  Prior Employment 
Employed By 
   
Address 
   
Employer’s Phone 
   
Occupation 
   
Name of Supervisor 
   
Monthly Gross Pay 
   
  From/To  From/To  From/To 
Dates of Employment 
   
 
CREDIT HISTORY 
  Bank/Institution Name  Balance On Deposit or Balance Owed 
Savings Account 
  
Checking Account 
  
Credit Card 
  
Auto Loan 
  
 
VEHICLES (Include vehicles belonging to other proposed occupants also) 
Make  Model  Color  Year  License Plate