RENTAL APPLICATION
Name ________________________________ Direct Phone ____________________
Home Tel #_________________________ Work Phone ___________________________________
Driver's license number ______________________Date of Birth___________________
Present Address _____________________________________________________________________
How long at this address? ______________ Rent ? _________Own? _________ Reason for
Moving_________________________________
Owner/Landlord __________________________ Phone ___________________________________
Previous Address _____________________________________________________
How long at this address? ______________ Rent $ __________________ Reason for Moving
________________________________
Owner/Manager _________________ Phone ________
Name and relationship of every person to occupy premises, even if only temporarily (include names and ages of minors):
_____________________________________________________
_____________________________________________________
Any pets? ______ Describe ________________________________
Occupation ________________________
Employer ___________________________________________
Phone _______________________________
Duration of Employment _______ Supervisor ________________________________ Phone
_________________________
List sources of income (other than employment listed above ___________________________________________
_____________________________________________________
HAVE YOU...
ever filed bankruptcy? ____ ever been evicted? ____ ever been convicted of a felony? ___ ever been foreclosed on?
____. PLease explain:_______________________________________________
Vehicle Make __________ Model ____________ Year _________ License ___________
Vehicle Make __________ Model ____________ Year _________ License ___________
Personal Reference __________________________________
Address _____________________________
Phone ________________
Contact in Emergency ___________________________________
Address _____________________________
Phone ________________
Vehicle (1) Year _________Make _____________________Model ___________________________
Vehicle (2) Year _________Make _____________________Model ___________________________
I declare that the information provided above is accurate and correct. I authorize verification of my references and
employment as they relate to my tenancy and to future rent collection.
___________________________ _______________________
Application Date_____________________________
your email_____________________________________________________
FAX FORM TO: 239-430-6034 OR SCAN IT AND THEN EMAIL IT TO mrsalomon34102@yahoo.com, please
attach copy of your driver's lic.