RENTAL APPLICATION EACH PERSON MUST FILL OUT AN APPLICATION
DESIRED MOVING DATE __________________________________________________________
How you heard of us ____ Newspaper ____ Sign ____ Friend ____ Web _____ Other ____________
FULL NAME __________________________________________ BIRTH DATE _______________
PHONE NUMBERS _____________________•_____________________•____________________
home work cell
SOCIAL SECURITY # ______________ DRIVER’S LICENSE # _____________ STATE ________
PEOPLE TO LIVE WITH YOU
1. _________________________________________________________________________
full name relationship age
2. _________________________________________________________________________
full name relationship age
DO YOU HAVE PETS? ______ IF SO, DESCRIBE ______________________________________
DO YOU HAVE A WATER BED? ________ DO YOU SMOKE? _________
DO YOU HAVE RENTER’S INSURANCE? ________ INSURANCE COMPANY _________________
PRESENT ADDRESS _____________________________________________________________
NAME(S) ON LEASE ______________________________________________________________
RENT $ _________ / month FROM ______________________ TO ______________________
REASON FOR MOVING ____________________________________________________________
OWNER/MANAGER ________________________________________ PHONE #______________
PREVIOUS ADDRESS _____________________________________________________________
NAME(S) ON LEASE ______________________________________________________________
RENT $ _________ / month FROM _______________________ TO ______________________
REASON FOR MOVING ____________________________________________________________
OWNER/MANAGER ___________________________________________ PHONE #____________
PRESENT OCCUPATION __________________________________________________________
EMPLOYER AND LOCATION ____________________________________ PHONE #____________
SUPERVISOR’S NAME _________________________________________ PHONE #____________
DATES WORKED FROM ________________________ TO ______________________________
PREVIOUS OCCUPATION _________________________________________________________
EMPLOYER AND LOCATION ____________________________________ PHONE # ___________
SUPERVISOR’S NAME _________________________________________ PHONE # ___________
DATES WORKED FROM ________________________ TO ______________________________
CURRENT GROSS INCOME PER MONTH (before deductions) $ ___________________________
OTHER SOURCES OF INCOME $ _________ per _____ OR ASSISTANCE $ ________ per______
ARE YOU A STUDENT? _______ SCHOOL NAME _______________________________________
LIST SOURCES OF ASSISTANCE ____________________________________________________
AMOUNT YOU RECEIVE $ ___________
AMOUNT OF CHILD SUPPORT/ALIMONY YOU PAY $ ____________ RECEIVE $ ____________
CHECKING ACCOUNT BANK
_______________________________________________________________________________
name city state
SAVINGS ACCOUNT BANK
________________________________________________________________________________
name city state
MAJOR CREDIT CARD ___________________ BALANCE OWED _________ PAYMENT_________
CREDIT REFERENCE _____________________________________________________________
HAVE YOU EVER FILED FOR BANKRUPTCY? ______ HAVE YOU EVER BEEN EVICTED? _______
TOTAL NUMBER OF VEHICLE(S) ______________ * NOTE: Only 2 vehicles per apartment allowed.
_______________________________________________________________________________
make model year color license plate # state
_______________________________________________________________________________
make model year color license plate # state
PERSONAL REFERENCE
_______________________________________________________________________________
name phone # address
CONTACT IN EMERGENCY
_______________________________________________________________________________
name phone # address
Have you been or are you presently an illegal user of a controlled substance? _________________
I declare that the above statements are true and correct, and I hereby authorize verification of
given references and a credit check.
X _____________________________________________________________________________
signature date
| PLEASE RETURN COMPLETED APPLICATIONS TO: Kirk Walters P.O. Box 137 North Liberty, IA 52317 Or fax to (319) 626-4542 |
| *Note: If you have additional information, please use a separate sheet of paper and attach to this form. |
| PLEASE RETURN COMPLETED APPLICATIONS TO: Kirk Walters P.O. Box 137 North Liberty, IA 52317 Or fax to (319) 626-4542 |
| www.apartmentsbywalters.com/ Phone: 319.626.2132 |