Date: _______(1)__________

Application is hereby made to rent premises generally described as

______________________(2)___________________________ for a term of ______(3)_______

and ending the ________(4)__________ day of ____________(5)______, __________(6)

______, for which monthly rental shall be $____(7)____, payable in advance, and for which a

security deposit of $____(8)____ shall be due prior to occupancy of the above-described


A deposit of $_________(9)__________ 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.


Name: __________________________________(10)


Present Address: ___________________(11)_____________________ How Long? ____(12)


Previous Address: __________________(13)______________________ How Long? ___(14)


Married: ____(15)____ Spouse's Name: ______________________(16)


Children? _______(17)_______ How Many? _______(18)_______ Ages? ________(19)_______

Pets? _______(20)_______ What Kind? ________(21)_________ How Many? ______(22)



Employer: _______________________________(23)


Employer Address: ________________________(24)


Supervisor: ____________(25)______________ Bus. Phone: ____________(26)


How Long on Present Job? __________(27)____________ Annual Income: ______(28)_______


Employer: _______________________________(29)


Employer Address: ________________________(30)


Supervisor: _____________(31)_____________ Bus. Phone: ____________(32)


How Long on Present Job? ________(33)_________ Annual Income: ________(34)__________


Bank: _________________(35)___________________ Phone: ___________(36)____________

Personal Reference: _________(37)_______________ Phone: ___________(38)____________

Credit Reference: ____________(39)______________ Phone: ____________(40)


Credit Reference: ____________(41)______________ Phone: ____________(42)



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 ________


The information in this document is designed to provide an outline that you can follow

when formulating business or personal plans. Due to the variances by many local, city, county

and state laws, we recommend that you seek professional legal counseling before entering into

any contract or agreement.

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Notice: Information provided in this website is not intended to substitute for professional advice, including but not limited to professional legal advice. If you submit a question or comment it is assumed that you are interested in soliciting, receiving or giving general information and not legal advice. Laws vary by state, and the laws described in this website may be different in your state or may have been changed since the information was posted. The legal help offered in this website comes from volunteers who may not have any formal legal training or knowledge, and all information should be confirmed with a qualified legal professional before use. All information is made available on an "as is" basis. You should accept legal advice only from a licensed legal professional with whom you have an attorney-client relationship. Use of this website is subject to the terms of use.

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