Residential Rent Application {LT-105}

[List landlord's name, address, and phone] RESIDENTIAL RENTAL APPLICATION (Each adult to complete separate application) Property/Unit: Please print clearly 1. Name of Applicant Phone Present Address How Long There? S.S. Number - - 2. Present Landlord Phone Address Monthly Rent Reason for Leaving 3. Previous Landlord Phone Address Monthly Rent How Long There? Reason for Leaving 4. Full names of all individuals (and ages of all children) who will be occupying premises 5. Pets (specify) 6. Have you ever been evicted, sued for nonpayment of rent, or breached a lease (if so, explain)? 7. Present Employer Phone Address Occupation Gross Monthly Salary Length of Employment 8. Previous Employer Phone Address Occupation Gross Monthly Salary Length of Employment 9. Other Income, if any (specify source) 10. Bank-Checking Account Account Number Address Approximate Balance 11. Bank-Savings Account Account Number Address Approximate Balance 12. Bank-Additional Account Account Number Address Approximate Balance 13. Credit Cards: (1) Bank Card Number (2) Bank Card Number (3) Bank Card Number 14. Loans: (1) Lender Balance Address Monthly Payment (2) Lender Balance Address Monthly Payment 15. Other Debts and Obligations, if any (specify) 16. Personal Reference Phone Address 17. Automobiles: Your License Number State (1) Make/Model Year Plate State (2) Make/Model Year Plate State 18. In case of emergency notify Address Phone I certify that the above information is true and complete. I authorize the verification of this information by contacting any or all individuals and financial institutions listed above. I understand that this is not a lease or an offer to rent. No binding obligation of any kind exists between the owner and myself unless and until a lease is signed. This Application is subject to prior Applications. This Application shall remain the property of the owner. Signature of Applicant Date Name of Applicant NO PERSON SHALL BE DENIED THE RIGHT TO RENT OUR PROPERTY BECAUSE OF THEIR RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN OR ANCESTRY. American LegalNet, Inc. © www.FormsWorkFlow.com