Housing Urban Management

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Rental Application

Rental address applied for *

First name *

Last name *

Phone *

Email *

Date of birth *

SSN (last 4 digits only) *

Address

Current address

City

State

Country

Zip

Which best describes your current housing situation?

Years at current address *

Enter the number of full years at your current address. If less than one year, select 0. Additional months will be collected in the next question.

Months at current address (0-11) *

Applicant type *

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Housing Payment Information

How will your rent be paid?

How many bedrooms are you looking for? *

What is your source(s) of income? *

Select more than one if applicable.

What is your gross monthly income? *

$

How will the security deposit be paid? *

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Rental History

How many years of rental history do you have? *

Have you had an eviction filed against you in the past 7 years? *

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Current Landlord Information

Name *

Phone *

Email *

Landlord mailing address

City

State

Zip

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Household Information

# Adults *

How many adults will be living in the household?

What are the names and ages of all adults in the household? *

# Children *

How many children or dependents will be living in the household?

Do you have any pets? *

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About You

Why are you moving? *

Select more than one if applicable.

Is there anything else you'd like the housing provider to know about you? (Optional)

Are you working with a Case Manager? *

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Case Manager Information

First name case manager *

Last name case manager *

Case Manager mobile *

Case Manager email

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Emergency Contact

Full name *

Relationship *

Phone *

Email

✅ Authorizations & Acknowledgments

Please review and accept each authorization below.

Verify Information
I authorize Housing Urban Management and its representatives to verify my employment, income, rental history, and other information needed to process my rental application. I authorize employers, housing providers, financial institutions, and other relevant third parties to release information related to my application.

Share Application Information
I authorize Housing Urban Management to discuss my application and share my application, supporting documents, screening information (where permitted), and other information needed to help me apply for rental housing with housing providers, property owners, property managers, and their authorized representatives. I understand this information will be shared only as reasonably necessary to process my application and identify housing opportunities that match my qualifications. This authorization remains in effect until I withdraw my rental application or revoke it in writing, except for actions already taken in reliance on this authorization.

Sell Products *

Rental Application Fee

$50

Rental Application

✅ Authorizations & Acknowledgments

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