<<<back

Right click and select "print". You can also email it to me or I can snail-mail one to you for completion.

 

 

What addrress are you interested in?__________________________

 

Name of all applicants including middle name ____________________________________________, __________________________________________

Phone _________________ Work phone _______________ email _______________________________

Present Address________________________________________________________________________

How many in your Household? Adults ______ Children______ Pets______ Breed____________ Weight_______

How long have you lived at your present address?____________ How long do you plan on staying at your next address?_____________

Number of smokers _____

Name of current landlords of all applicants __________________________, ____________________________ Phone________________, _________________

Prior landlords___________________________________, _____________________________ Phone ______________,_____________

Will your present and previous landlords give you a good reference? ________

Applicant's Employer ____________________________________Phone___________________

How long have you worked here? ______________, ____________

Job title________________________________ Supervisor ____________________________

Full or Part-time? ______________

Co-Applicant's Employer__________________________________ Phone__________________

How long have you worked here? ______________

Job title _____________________________ Supervisor ____________________________

Full or Part-time? ___________

Other income sources _______________________________________________________

Total weekly household income $_____________________

Current rent $_______ Will you get your deposit back?_______

Are you able to pay rent by the first of every month?___________

Are you able to transfer utilities and pay the deposit and first months rent prior to moving in? ______ Source of money_____________

Name and Social Security numbers of all prospective occupants.

_______________________________ _______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________ _______________________________

 

References, no more than one relative please

....................................Name .................................................Number.............................. Relationship.......

  1. ______________________________ ______________________ ____________________
  2. ______________________________ ______________________ ____________________
  3. ______________________________ ______________________ ____________________

** You must include a copy of your most recent pay stub(s) incomplete applications will be discarded **

I authorize the verification of my credit, employment, personal references, and public records in connection with the processing of this application.

________________________ Date ____________

 

_________________________ Date ___________ Mail completed application to:

RentIndependence.com

P.O. Box 365

Independence IA 50644 or email to RentIndependence@yahoo.com