Rental Application

Date Initial if over 18 year of age
Social Security No.

Name of Applicant Hm Phone Cell phone email

Street Address City State Zip Code

Current Landlord Name Landlord Address, City, State
Landlord Phone No.

Previous Landlord Name Address, City, & State
Phone No.

Name Current School Enrolled Major Program Length Year of Graduation Masters?

Current Employer Co. Address, City, State
Co. Phone No.

Position Business Type Salary/Year How Long in this Job?

Previous Employer Address, City, State
Phone No.

How Long in this Job?
Reference Address, City, State
Phone No.

Name of Family or Kin for emergency
How are they related to you?

Address, City, State, Country

Phone No.

Credit Card Name

Name of Bank where accounts are held

Are you a convicted felon? Yes / No


Apartment No. No. occupants? Adults Children
Base Monthly Rent

Address, City, State Pets? Ages of minor children First Month

Last Month
Months of Lease? Start Lease Lease expires Security Deposit

Key Deposit
Renting Agent


Balance Due

Pursuant to State and Federal Law, the management shall not make an inquiry concerning race, religion, color, national origin, sex, sexual orientation, age (except if a minor), ancestry, or marital status of the applicant or veteran status, military service, or handicapped.
The applicant authorizes the management and renting agency to obtain a consumer credit report. The applicant warrants and represents that all statements herein are true and accurate and agrees to execute a standard form apartment lease or tenancy at will agreement, a copy of which the applicant has had an opportunity to examine, which the Lessor may choose to terminate if statements made herein are untrue.
Deposits will be applied as shown above, or applied as damages sustained by the owner except if the application is not accepted by the owner.
The renting agent is an independent contractor and has no authority to make any representations concerning the premises; The renting agent is only authorized to show the apartment for rent and assist in screening applicants. Rolls Realty Inc. provides equal housing opportunity.