Test Application

Residency Application

* Indicates required field

Name *

First

Last

Phone Number *

Date of Birth *

Email *

Current Address *

Line 1

Line 2

City

State

Zip Code

Country

Landlord (Name & Address) *

Landlord Phone Number *

Rent Payment *

How long have you lived here? *

Reason for Moving *

Previous Address *

Line 1

Line 2

City

State

Zip Code

Country

Landlord Name & Address *

Landlord Phone Number *

Rent Payment *

How long did you live here? *

Reason for Moving *

Have you ever been charged with or convicted of a felony? *

If yes, please explain: *

Have you ever filed for bankruptcy? *

If yes, what was the date? *

Employment:

Present Employer *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Length of Employment *

Monthly Take-Home Pay *

Other Income *

References:

Personal References (No Relatives) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Nearest Relative & Their Relationship to You *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

In Case of Emergency, Please Notify *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please list Names of All Persons who will Occupy these Premises *

Phone Number *

Automobile

Make *

Color *

Model/Year *

License State & Number *

*Additional information may be required by the Landlord.

I hearby state and represent that the information in this application is complete and accurate. I understand that in the event a lease is entered into it may be cancelled by the Landlord if any of the information provided in the application is materially inaccurate or incomplete. I authorize Rex/Maggie Rasmussen to verify the above information. A credit report and background check will be obtained on all applicants. If I should cancel this application after 2 days from the date of the application, the ENTIRE deposit will be retained as termination charges. I also understand that PETS ARE NOT ALLOWED.

I agree to the terms above *

I agree

Submit