RENTAL APPLICATION

Prospective Address:

For Office Use Only:

Rent:
Total Security Deposit:
Pet Rent/Deposit:

Date/Time Received (order):

Received By:
Total Points:

Tenants Name:
Date of Birth:
Drivers License #:
Email Address:

Desired Length of Occupancy:

Desired Date of Occupancy:
Home Phone:
Cell Phone:

Co-Tenants Name:
Date of Birth:
Drivers License #:
Cell Phone:
Email Address:
Other Tenants:
1.
2.
3.
4.
Present Address:
City:
Why are you moving?
Current Rent:
Present Landlord Name(s):

Age

Co-Tenants Name:
Date of Birth:
Drivers License #:
Cell Phone:
Email Address:
Relationship to applicant

State:

Occupation

How long have you lived at this address?

Utility Payment:

Current Lease Expires:

Phone:

5-Year Residential History

Please list all of the addresses you lived in for the past 5 years:
Address
Start Date Finish Date
Landlords Name / Phone
1.
2.
3.
4.
5.
Vehicle Information:
Make:
Model:
Make:
Model:

Year:
Year:

License Plate #:
License Plate #:

Loan Amount:
Loan Amount:

Pet Information: Type / Breed

1.
2.
3.

Age

Length of Ownership

Professional References (no friends or family):

1.
2.
3.

Phone

Relationship

Financial Information
Occupation:
Employer:
Business Address:
Business Phone:
Position / Title:
Supervisor
Name / Title / Phone:
How Long?
Gross Income (Month):
Source:

Tenant

[ ] Wages [ ] Commission [ ] Salary

[ ] Tips [ ] Govt Asst [ ] Other:

Co-Tenant

[ ] Wages [ ] Commission [ ] Salary

[ ] Tips [ ] Govt Asst [ ] Other:

Previous Employer:
How Long?
If you have other sources of income that you would like us to consider please list:
Amount $
Per
Source
Amount $
Per
Source
Miscellaneous Information:
Rate your/co-applicants cleanliness on a scale of 1 (least) to 5 (most):
Do you/co-applicant smoke?
[ ] Yes
- Inside your home?
[ ] Yes
- Outside of your home?
[ ] Yes
Have you/co-applicants ever been convicted of or pled no contender to a felony?
[ ] Yes
Have you/co-applicants ever been evicted from any tenancy?
[ ] Yes
Have you/co-applicants ever been party to any unlawful detainer action or filed for bankruptcy?
[ ] Yes
Have you/co-applicants ever willfully and intentionally refused to pay rent when due?
[ ] Yes
Have you/co-applicants had two or more late rental payments in the past year?
[ ] Yes
Do you know of anything, which may interrupt income or ability to pay rent?
[ ] Yes
If yes, please explain:
Please explain any other debts and obligations: (credit card debt, loans and balances, monthly payments, etc.)
Debt/Obligation:
Amount owed/month:
Debt/Obligation:
Amount owed/month:
Debt/Obligation:
Amount owed/month:
Debt/Obligation:
Amount owed/month:

[
[
[
[
[
[
[
[
[

] No
] No
] No
] No
] No
] No
] No
] No
] No

I hereby certify the answers I have given in this application are true and correct. I understand any false answers or
statements made by me will be sufficient grounds for eviction and loss of any security deposit.
Applicant permits a credit check and background check on him/her-self and co-applicants by signature(s) below:
Applicant:

Date:

Co-Applicant:

Date:

Co-Applicant:

Date:

Is there any additional information about yourself that you would like to share? (ex. Skills, history, likes and dislikes,
previous renting experiences, knowledge of home repair, etc.)
Discrimination:
It is against the law to discriminate against tenants on the basis of race, religion, national origin, age, or neighborhood
racial makeup.
Mail to:
Tim or Kristi Loose
17457 225th Street
New Ulm, MN 56073
timothyoloose@yahoo.com or kristiandersen@yahoo.com