RENTAL APPLICATION Apartment Address: _________________________________________________________________ Applicant #1: Full Name________________________________________ Birthdate________________________ Social Security Number _______________ Telephone (h)______________ (w)______________ Current Address _____________________________ Rent ________ Time There __________ Current Landlord ____________________________ Landlord Telephone __________________ Previous Address ____________________________ Prev Landlord Phone __________________ Current Employer ________________________ Position ____________ Time There ________ Supervisor Name ________________ Supervisor Phone _________ Monthly Gross $_________ Previous Employer _________________________ Position ____________ Time There _______ Supervisor Name _______________ Supervisor Phone __________ Monthly Gross $_________ Applicant #2: Full Name________________________________________ Birthdate_________________________ Social Security Number _______________ Telephone (h)_____________ (w)_______________ Current Address _________________________________ Rent ______ Time There _________ Current Landlord ______________________________ Landlord Telephone _________________ Previous Address ______________________________ Prev Landlord Phone ________________ Current Employer _____________________ Position ______________ Time There _________ Supervisor Name __________________ Supervisor Phone ________ Monthly Gross $________ Previous Employer ______________________ Position ____________ Time There _________ Supervisor Name _________________ Supervisor Phone __________ Monthly Gross $_______ Name and Relation of All Persons to Occupy Apartment (not listed above):____________ ____________________________________________________________________________________ Any Pet to Occupy Apartment (List type and Weight)? ________________________________ Additional Pet Deposit May Be Required. Name to Contact in Emergency: ______________________________________________________ Emergency Contact Telephone: ______________________________________________________ Have you Ever Filed Bankruptcy? (Discuss Below) _______ Have you ever been evicted? (Discuss Below) ________ Are there any issues related to your credit report that require explanation? (Discuss Below) ________ Additional Info :___________________________________________________________________ ____________________________________________________________________________________ This is to certify that the information in this application is true and correct to the best of my (our) knowledge and if any information is found to be fraudulent, the owner will have no obligation to rent to the undersigned. I authorize the owner or his agent to investigate my (our) employment, credit record and rental history through contact with credit bureaus, employers and landlords. Applicant agrees that a copy of this application may be mailed or FAXed to credit bureaus, employers and landlords who require written authorization before disclosing information about the applicant. Sign ________________________________________ Date ___________________ Sign ________________________________________ Date ___________________ A nonrefundable application fee of $20 must accompany application. All Applications are subject to the approval of the owner. Return to A. J. Szumski 804.370.7479