Rental Application

Landlords Cell: 919-260-1431 --- FAX: 919-929-1231 --- email: brianj999@gmail.com 
Please complete, sign and either (1) Scan, and email back; or (2) FAX back (no cover sheet necessary).  
 
Property Applied For:________________________________

Name __________________________________________ Home Phone________________________

Social Security Number _____________________________ Work Phone _______________________ 
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Present Address _____________________________________

How long at this address ________________________________________ Rent _________________

reason for moving _____________________________________________________________

Owner/Manager __________________________________ Phone ______________________
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Previous Address ____________________________________

How long at this address _____________________________________ Rent ____________________

Reason for moving _____________________________________________________________

Owner/Manager __________________________________ Phone ______________________
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Name and Relationship of every person to live with you: ___________________________________________ 

___________________________________________________________________________________________

Any Pets _________________ Describe __________________________________ Waterbed? ___________ 

Occupation ____________________ Employer ___________________________Phone________________

Current gross income per month (before deductions) _______________________________________ 

List sources of income (other than employment listed above)_________________________________

Have you ever filed for bankruptcy? ___________________________________________________

Have you ever been evicted? _________________________________________________________ 

Vehicle Make(s)______________________ Model(s)_______________ Year(s) _______________ 

Personal Reference Name: ___________________City: ______________ Phone:_________________

Emergency Contact (Parent): _________________City: _______________Phone:_________________ 

I (we) declare that the forgoing information is correct and hereby authorize verification and the obtaining of a consumer credit report.

Signature ________________________________________________ Date ____________________

Applicant Email Address (if available) ________________________________