RENTAL APPLICATION FOR FAMILY HOUSING

All sections are required:

Last Name First Name Middle Name Soc. Sec. #
Date of Birth Driver's Lic. # State Home Phone #

Present Address City State Zipcode
Date In Date Out Owner/Mgr. Name Owner/Mgr. Phone
Reason for Moving

Previous Address City State Zipcode
Date In Date Out Owner/Mgr. Name Owner/Mgr. Phone
Reason for Moving

Next Previous Address City State Zipcode
Date In Date Out Owner/Mgr. Name Owner/Mgr. Phone
Reason for Moving

Proposed Occupants (List all in addition to yourself)
Name Age Name Age
Name Age Name Age
Name Age Name Age
Name Age Name Age
Will you have pets? YesNo Describe
Will you have liquid filled furniture? YesNo Describe

Present Occupation Employer Name
How long with this employer? Employer Address
Name of Supervisor Employer Ph. #

Prior Occupation Employer Name
How long with this employer? Employer Address
Name of Supervisor Employer Ph. #

Current Gross Income? Per WeekMonthYear
Please list ALL of your financial obligations below.
Name of Creditor Address Phone Number Mon. Pymt. Amt.

In Case of Emergency Notify
Contact Name* Relationship*
Address City State Phone
Contact 2 Name Relationship
Address City State Phone

Personal References
Reference Name Length of Acuaintance
Occupation Address Phone
2nd Reference Name Length of Acuaintance
Occupation Address Phone

Automobiles
Make Model Year Lic. Plt. #
Make Model Year Lic. Plt. #
Motorcycles (Other Vehicles)

Have you ever filed for bankruptcy? YesNo
Do you smoke? YesNo
Have you ever been evicted or asked to move? YesNo
Have you ever served in the military? YesNo

APPLICANT REPRESENTS THAT ALL THE ABOVE STATEMENTS ARE TRUE AND CORRECT AND HEREBY AUTHORIZES VERIFICATION OF THE ABOVE ITEMS INCLUDING BUT NOT LIMITED TO THE OBTAINING OF A CREDIT REPORT AND AGREES TO FURNISH ADDITIONAL CREDIT REFERENCES ON REQUEST.
THE UNDERSIGNED MAKES APPLICATION TO RENT HOUSING ACCOMMODATION DESIGNATED AS:
Apt. No Located At
The rental for which is $ Per
I understand that this is a routine application to establish credit, character, employment and rental history. I also understand that this is NOT an agreement to rent and that all applications must be approved. I authorize verification of references given. I declare that the statements above are true and correct, and I agree that the landlord may terminate my agreement entered into in reliance on any misstatement made above.
Dated:

Office Address:
334 East Center St.
Provo, UT 84606
Phone (801) 607-1680
Fax (801) 377-4343
Applications are accepted after hours via fax or in the drop box.
How did you hear about us? (friend, ksl, craigslist, byu.edu, sign)
Desired move-in date: Email Address