Rental Application

Applicant Information

Applicant Name *

First Name

Middle Name

Last Name

Applicant Social Security Number *

xxx

xxxx

Applicant Birth Date *

Month

Day

Year

Applicant Current Address *

Street Address *

City *

State *

Zip *

Applicant Email *

Applicant Home Phone * xxx-xxx-xxxx

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Email *

Emergency Contact Phone * xxx-xxx-xxxx

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Employment

Employer Name *

Employer Address

Street Address

City

State

Zip

Employer Phone * xxx-xxx-xxxx

Employer Email

Position Held *

Employment Date Start *

Month

Year

Employment Date End

Month

Year

Monthly Gross Salary *

$ .00

Supervisor Name *

Supervisor Title

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Rental History

Rental Address *

Street Address *

City *

State *

Zip *

Rental Date Start *

Month

Year

Rental Date End *

Month

Year

Monthly Rent *

$ .00

Reason For Leaving *

Landlord Name

Landlord Phone xxx-xxx-xxxx

Next Section

References

Reference Name *

Reference Relationship *

Reference Phone Number * xxx-xxx-xxxx

Reference Email

Next Section

Custom

Property requested *

Street Address *

City *

State *

Zip *

Lease Term (months) *

Move-In Date *

Month

Day

Year

Monthly Rent *

$ .00

Number of Occupants *

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Terms and Conditions

By checking the "I Agree" box below and submitting this application, you (the Applicant) are agreeing to the following:

1. The Landlord may use this Application and the information in it to establish whether the Applicant meets the Landlord's selection criteria including credit, criminal, eviction, and employment backgrounds.
2. The Applicant authorizes the Landlord to verify via email or direct contact any references given in this Application.
3. The Applicant declares the information submitted in this Application to be true and correct to the best of his/her knowledge and understands that any misinformation provided herein may be cause for termination of any rental agreements made between the Applicant and the Landlord.
4. This Application is not a rental agreement and the Applicant does not have any rights to the rental property until a lease or other rental agreement is executed.
5. Applicant agrees to pay City & Suburban Homes Co., Inc. a $75.00 fee to process the application. A copy of the credit report will be made available to the Applicant upon request.

Agree To *

Your application submission may take up to a minute to process.