Secure Online Rental Application

*All data submitted through this form is transmitted with 128-bit encryption to protect your privacy.

Which property are you interested in?

Rental Address

Rent Amount

$

Desired Occupancy Date

How many persons will be living at premises?

Adults (18 or older : Must complete personal Information) Children

Personal Information

Applicant Name (18 or older : Must complete personal Information)

1.

Telephone #

Social Security #

Birth Date

Applicant Name (18 or older : Must complete personal Information)

2.

Telephone #

Social Security #

Birth Date

Applicant Name (18 or older : Must complete personal Information)

3.

Telephone #

Social Security #

Birth Date

Applicant Name (18 or older : Must complete personal Information)

4.

Telephone #

Social Security #

Birth Date

Driver's License #

1.

DL State

Email Address

Driver's License #

2.

DL State

Email Address

Driver's License #

3.

DL State

Email Address

Driver's License #

4.

DL State

Email Address

Current Address

Street

City

State

Zip

Do you rent or own this property?

Rent Own

Manager/Owner/Lender Name

Telephone #

Rent/Mortgage Payment

Length of Tenancy

Previous Address (If current address is less than 3 years)

Street

City

State

Zip

Do you rent or own this property?

Rent Own

Manager/Owner/Lender Name

Telephone #

Rent/Mortgage Payment

Length of Tenancy

Current Employment

Company

1.

Supervisor

Telephone #

Employment Length

Salary & Pay Period (hr/wk/mo)

Company

2.

Supervisor

Telephone #

Employment Length

Salary & Pay Period (hr/wk/mo)

Company

3.

Supervisor

Telephone #

Employment Length

Salary & Pay Period (hr/wk/mo)

Past Job History (If current Employment is less than 3 years)

Company

1.

From

To

Reason for Leaving

Company

2.

From

To

Reason for Leaving

Current Debts

Creditor

1.

Current Total Owed

$

Payments & Pay Period (wk/bi-wk/mo)

Creditor

2.

Current Total Owed

$

Payments & Pay Period (wk/bi-wk/mo)

Creditor

3.

Current Total Owed

$

Payments & Pay Period (wk/bi-wk/mo)

Creditor

4.

Current Total Owed

$

Payments & Pay Period (wk/bi-wk/mo)

Has anyone on this application filed Bankruptcy?

Yes No

If so, please explain:

Do you have any prior evictions?

Problems with Previous Landlords/Payable Rents?
Yes No

If so, please explain:

 Yes No

If so, please explain:

Have you ever been convicted of a felony OR misdemeanor?

Yes No

If so, please explain:

When did the conviction(s) occur?

References

Name

1.

Relationship (at least 2 unrelated)

Telephone #
2.
3.
4.

Will there be any SMOKERS on premises?

 Yes No

Will there be any PETS on premises?

 Yes No

If "YES", explain:

Additional Information

I certify that the above information is correct and truthful and I give REALTY SPECIALISTS permission and consent to obtain the above information in addition to a credit report, eviction records, and federal and state background checks as needed.

Signature of Applicant #1

Signature of Applicant #2
Please type your full name as a digital signature, signifying you have read and understood all terms of this application.