Secure Form Submission (SSL)
 Rental Application 

APPLICATION FOR RESIDENCY AND REQUEST FOR CREDIT REPORT

IT IS IMPORTANT THAT ALL THE FOLLOWING INFORMATION BE GIVEN:

1) First Name: MI Last Name:    SS#:
    Date of Birth: (i.e.-MMDDYY)     Home Phone: () -   
    Email:      Cell Phone: () -

2) Current Address - Street:   City:   State:   Zip:
    How Long?   Name of Landlord/Mortgage Co.:
    Their Phone #:   Monthly Rent/Mortgage Payment: $
    Mortgage Account #:

3) Previous Address (if less than 2 years at current address)   How Long?
    Previous Address - Street:   City:   State:   Zip:
    Name of Landlord/Mortgage Co.:
    Their Phone #:   Monthly Rent/Mortgage Payment: $
    Mortgage Account #:

    (If #2 and #3 do not total 2 years of residence, please complete the section below)   How long?
    Previous Address - Street:   City:   State:   Zip:
    Landlord:   Their Phone #:   Rent: $

4) Employer:   How Long?
    Business Address:   Phone #:
    Position:   Base Salary: $
    Other Income: $   Source:

5) Previous Employment (if less than 1 year at present position):
    Employer:   How Long?
    Business Address:   Phone #:
    Position:   Base Salary: $

6) Additional Occupants: How Many?
    Name:   SS#: - -   Date of Birth: (i.e.-MMDDYY)
    Employer:   How Long?
    Business Address:   Phone #:
    Position:   Base Salary: $
    Other Income: $   Source:

7) Pets: How Many?   What Type:

8) TOTAL Outstanding Debt: $   (include credit cards, car payments, loans, etc.)
    Average monthly payments toward your total outstanding debt: $

9) Payments: Alimony $   Child Support $   Other $

10) Are there any past or current tax liens, judgments or lawsuits against any applicant?
    Yes No   TYPE:

11) Has any applicant ever filed bankruptcy? Yes No   If Yes - Date:   Type:

12) Notify in case of Emergency:   Phone #:
      Address:   Relationship:

13) Reference:   Phone #:
      Address:

14) Remarks (unusual circumstances):
     

OPTIONAL
Application is made to lease the premises known as
for year(s) beginning on the day of , 20, for the monthly rent of $, payable in advance on the first day of each month.

List price: $

I (We) certify that the foregoing information is true and accurate to the best of my (our) knowledge. I (We) authorized Realty One Group, Inc. and its Associate, BARRY ZWEIG, to obtain a credit report and rental history on me (us) and provide the owner ONLY with a copy. I (We) understand that my (our) application for residency may be accepted or denied as a result of the credit report and/or rental history. If I (we) desire a copy of the credit report, I (we) must personally obtain it from a credit reporting bureau.

The above terms and conditions are hereby approved and accepted, and receipt of copy is hereby acknowledged.

Applicant:   Date:   Applicant:   Date:

Realty One Group, Inc.: BARRY ZWEIG



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