LANDLORD APPLICATION

Name of Applicant________________________________________________ Phone_____________________

Social Sec. No.______________ Driver’s License No.__________________ State_______Exp ___________

Residence

Present Residential Address___________________________________________________________________

How Long __________ Rent Own (circle one)

Renting?
Name of Rentor_____________________________
Rentor’s phone _____________________________
Do you pay on time? yes no
If not, why not? ______________________________
___________________________________________
Own?
Is the mortgage paid up? yes no
If not, name of bank holding mortgage ____________
___________________ Bank phone _____________
Mortgage payment amount _____________________
Is there a tax lien against this property? yes no

Previous Residential Address___________________________________________________________________

How Long __________ Rent Own (circle one)

Employment

Employed Own Business

Name of Employer____________________________
Employer’s phone ____________________________
Position Title ________________________________
How long there? ______________________________
If not there anymore, circle one: quit laid off
Were you fired for cause? yes no
Name of Business_____________________________
Business phone _______________________________
Position Title ________________________________
How long have you been in business? _____________
Business license no. ___________________________
State in which business is registered ______________

Previous Employer____________________________ Better Business Bureau Rating __________________

Employer’s phone ____________________________
Position Title ________________________________ Have you ever filed for bankruptcy? yes no
How long there? ______________________________ If yes, how many times?________________________
Circle one: quit laid off

Were you fired for cause? yes no

Other sources of income__________________________________________ Amount pr year ______________

Other sources of income__________________________________________ Amount pr year ______________
 References - Landlord History

Please include name of past rentors of your property(s) and phone #

1.

2.

3.

Bank Information

Bank Name:___________________________________________ Phone: ______________________________

Account No. _______________________________________________________________________________

HAVE YOU EVER

* Been the target of an official complaint from a former tenant of your property(s)? yes no
If so, what where the circumstances? ___________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Was the complaint resolved? yes no

* Been sued by a tenant for landlord related legal violations which include (but are not limited to): failure to
perform basic property upkeep, willfull neglect of property safety or failure to return a damage deposit in
whole or in part, when deserved by tenant? yes no
If yes, please cite
court case location____________________________ case #_________________________ date____________
court case location____________________________ case #_________________________ date____________
court case location____________________________ case #_________________________ date____________

* Been tried on a criminal offense, and the case against you dismissed? yes no
* Been convicted of a criminal offense? yes no
Charge___________________________ court location _____________________________________________
case #____________________________________________________________________ date ____________

ACKNOWLEDGEMENT AND CONSENT TO CREDIT CHECK

I _______________________________________________, declare the foregoing information is true and

correct, and I hereby authorize you to conduct an employee, bank and legal check to verify references. I agree
that the rentor/tenant may terminate any lease agreement for said property when relying on any misstatemnents
above.

____________________________________________________________________________
Applicant’s Signature date
copyright 2009 Renters’ Alliance