Housing Urban Management

Rental Application

First and Last Name *

Do you have a middle name? *

Middle name *

Phone *

Applicant type *

# Adults *

Include yourself in this count as well as any other persons 18 years of age or older who will reside with you.

Age of primary applicant *

# Children *

Name(s) and age(s) of children *

Pets *

Pet Description *

Co-applicant name #1 *

Co-applicant email #1

Co-applicant name #2 *

Co-applicant email #2

Rental History *

How long have you been at your current residence? *

Current address *

Provide full address including unit number, city, state and zip code.

Move-in date for current residence *

Landlord recommendation *

What would you current housing provider say about your relationship when we contact him/her for a reference?

Why are you moving? Is there anything that your current landlord could have done to make you stay? *

Are you the primary leaseholder at this address? *

Were you the primary leaseholder at your previous address? *

Previous address *

Provide full address including unit number, city, state and zip code.

How long were you at your previous residence? *

Evictions *

What were the circumstances surrounding the eviction? *

Current landlord name *

Current landlord phone *

Current landlord email

Current landlord address *

Provide full address including unit number, city, state and zip code.

Funding Type *

Source of Income *

Select more than one item if applicable.

Gross Monthly Income *

Move Type *

Tenant Portion *

Date of birth *

Social Security Number *

Authorization to Release Information.

The applicant under the penalties of perjury that I have read and understand the questions contained in this application and that my answers to the questions on this application are true and correct to the best of my personal knowledge, information and belief and that I have not knowingly withheld any fact or circumstance which would, if disclosed, affect my application unfavorably.The Applicant hereby authorizes the Company to order and obtain a credit/consumer report. I hereby authorize the owner or owner's agent to whom this Application is made and any credit bureau or other investigative agency used by such owner or owner's agent to investigate and to report and disclose to the owner's agent the results of the references herein listed, statements and other data obtained from me or from any other person pertaining to my credit, employment, rent history and financial responsibility. The applicant hereby releases the Company from any liability whatever for rejection of this application due to credit information or any other reason. After this application has been processed, the owner may be contacted for final approval. Applicant will be contacted when approval is received or denied.I understand that this APPLICATION DOES NOT CONSTITUTE A COMMITMENT to lease or rent and that a WRITTEN LEASE WILL BE PREPARED if my application is approved. I further understand that the lease MUST BE SIGNED BY ALL PARTIES IN ORDER TO BE VALID.*

Amount Due *

Rental Application

$50

$40

Admin Code

Pay Later *

Select 'TRUE' if you'd like to pay the rental application fee later.

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