ERRICS REALTOR
APPLICATION FOR RENTAL
Notice: Some columns are for the Landlord and Realtor to fill and all applicant must be 18 and above.
APARTMENT RENT START DATE AGENT/REFERRED BY
APPLICANT INFORMATION
LAST NAME FIRST NAME M.I. SSN DRIVER'S LICENSE #
BIRTH DATE HOME PHONE WORK PHONE EMAIL
( ) ( )
MARITAL STATUS RELIGION
CURRENT ADDRESS
STREET ADDRESS CITY STATE ZIP
DATE IN DATE OUT LANDLORD NAME LANDLORD PHONE
)(
MONTHLY RENT REASON FOR LEAVING
$
PREVIOUS ADDRESS
STREET ADDRESS CITY STATE ZIP
DATE IN DATE OUT LANDLORD NAME LANDLORD PHONE
)(
MONTHLY RENT REASON FOR LEAVING
$
OTHER OCCUPANTS
LIST NAMES AND BIRTH DATES OF ALL ADDITIONAL OCCUPANTS 18 YEARS OR OLDER
LIST NAMES AND BIRTH DATES OF ALL OCCUPANTS 18 YEARS OR YOUNGER
PETS
PETS? DESCRIBE
EMPLOYMENT INFORMATION
1. OCCUPATION EMPLOYER/COMPANY
SUPERVISOR NAME SUPERVISOR PHONE
( )
2. OCCUPATION EMPLOYER/COMPANY
SUPERVISOR NAME SUPERVISOR PHONE
( )
EMERGENCY CONTACT
1. NAME ADDRESS PHONE RELATIONSHIP
(
2. NAME ADDRESS PHONE RELATIONSHIP
ERRICS REALTOR
BACKGROUND INFORMATION
HAVE YOU EVER: Filed for bankruptcy? Willfully or intentionally refused to pay rent when due?
Been evicted from a tenancy or left owing money? If yes, please provide Property Name, City, State, and Landlord Name.
Yes No
Been convicted of a crime? If yes, please provide Type of Offense, County, and State.
Yes No
VEHICLE INFORMATION
1. MAKE & MODEL YEAR LICENSE NO. & STATE
2. MAKE & MODEL YEAR LICENSE NO. & STATE
OTHER VEHICLES
OTHER INFORMATION
HOW DID YOU HEAR ABOUT THIS PROPERTY?
PLEASE INCLUDE ANY OTHER INFORMATION YOU BELIEVE WOULD HELP TO EVALUATE THIS APPLICATION
I/we, the undersigned, authorize ERRICS REALTOR, Landlord and its agents to obtain an investigative consumer credit
report including but not limited to credit history, OFAC search, landlord/tenant court record search, criminal record search and
registered sex offender search. I authorize the release of information from previous or current landlords, employers, and bank
representatives. This investigation is for resident screening purposes only, and is strictly confidential. This report contains
information compiled from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold
ERRICS REALTOR, Landlord and its agents free and harmless of any liability for any damages arising out of any improper
use of this information.
Important information about your rights under the Fair Credit reporting Act:
• You have a right to request disclosure of the nature and scope of the investigation.
• You must be told if information in your file has been used against you.
• You have a right to know what is in your file, and this disclosure may be free.
• You have the right to ask for a credit score (there may be a fee for this service).
• You have the right to dispute incomplete or inaccurate information. Consumer reporting agencies must correct
inaccurate, incomplete, or unverifiable information.
______________________________________
(Signed/Applicant) Date (Signed/Realtor) Date
______________________________________________
(Signed/Landlord) Date
