RENTAL UNIT ADDRESS APPLIED FOR:

DATE OF APPLICATION:                                                    Unit Shown By:

YOUR CONTACT PHONE NUMBER:

The information below must be fully completed for any and all adults (18 & over) to be residing in unit.

ALL APPLICANTS ARE REQUIRED TO PRESENT A VALID GOVERNMENT ISSUED ID.

Adult #1 – Full Name:                                                 

Social Sec. #:

Employer:

Date Employed:

Employer Phone Number:

Gross Income:                                  hourly/weekly/monthly

Vehicle Year/Make/Model:

Color:

License Plate #:

Adult #2 – Full Name:                                                 

Social Sec. #:

Employer:

Date Employed:

Employer Phone Number:

Gross Income:                                  hourly/weekly/monthly

Vehicle Year/Make/Model:

Color:

License Plate #:

Adult #3 – Full Name:

Social Sec. #:

Employer:

Date Employed:

Employer Phone Number:

Gross Income:                                  hourly/weekly/monthly

Vehicle Year/Make/Model:

Color:

License Plate #:

Name and Age of Children (under 18) to be residing in unit

Child #1 – Name:                                                                                            Date of Birth:

Child #2 – Name:                                                                                            Date of Birth:

Child #3 – Name:                                                                                            Date of Birth:

PET    Breed:                    Color:                     Name:                        Age:            Height/Weight:

Emergency Contacts:  Name, Address & Phone Numbers of two people not living with you

Contact #1 – Name:

Relationship:

Address:                                                                                                           Phone #:

Contact #2 – Name:

Relationship:

Address:                                                                                                           Phone #:

CURRENT ADDRESS:

Landlord’s Name & Phone Number:

Lived here from:                                to:                                             Amount Paid Monthly:                     

Reason for moving:

PREVIOUS ADDRESS:

Landlord’s Name & Phone Number:

Lived here from:                                to:                                             Amount Paid Monthly:                     

Reason for moving:

PREVIOUS ADDRESS:

Landlord’s Name & Phone Number:

Lived here from:                                to:                                             Amount Paid Monthly:                     

Reason for moving:

Have you ever been convicted of a crime?      Y    N                    Have you ever been evicted?    Y    N

Have you ever filed Bankruptcy/Foreclosure?   Y      N               Have you ever refused to pay rent?   Y   N

If you answered yes to any of these questions, please explain:

RADON GAS   Notice to Prospective Tenant: Radon is a naturally occurring radioactive gas, that when it has accumulated in a building is sufficient quantities, may present health risks to persons who are exposed to it over time.  Levels of radon that exceed federal and state guidelines have been found in building in this state.  Additional information regarding radon and radon testing may be obtained from your county public health unit.

LEAD PAINT DISCLOSURE  “Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning.  Lead poisoning in your children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems and impaired memory.  Lead poisoning also poses a particular risk to pregnant women.  The seller of any interest in residential real estate is required to provide the buyer with any information on lead-based paint hazards from risk assessment or inspection in the seller’s possession and notify the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase.”

I/We, the undersigned, understand that D & J PROPERTY MANAGEMENT, INC. is the leasing agent and representative for the owner/landlord and that the leasing agent’s fee will be paid by the owner/landlord.  The undersigned acknowledge that this written notice was received prior to the undersigned receiving a lease agreement.

I/We declare the foregoing information is true and correct.  I/We hereby authorize you to conduct an employment and credit check and to verify our references.

If this application is not fully completed, it cannot and will not be processed.  Please double check that ALL blank lines and questions have been fully completed and answered to the best of your knowledge.

Applicant’s Signature:                                                        Date                        Co-Applicant’s Signature:                                  Date