RENTAL APPLICATION

The undersigned hereby makes an application to rent the property located at:
__________12237 Wolff Place, Broomfield, CO 80020 __________________________.
Anticipated move date of ___________________at a monthly rent of $_______________ and security deposit of
$_______________.

PLEASE TELL US ABOUT YOURSELF

Full Name______________________________________________ Home Phone ( ) ___________________

Date of Birth__________________________________ Social Security #________________________________
Email Address:____________________________________(optional) Other Phone ( ) _________________
Co-Applicant Name_______________________________ Names of Dependents_________________________
Co-Applicant Date of Birth______________________ Social Security #_________________________________
Dependents Date of Birth______________________________________________________________________
List All Pets_________________________________________________________________________________
*NOTE: No pets are allowed at any time on the premises without prior Management consent and payment of fees.
NO EXCEPTIONS.
Other persons, including children who will live in the dwelling unit
Name_______________________________________ Name ________________________________________
Name_______________________________________ Name ________________________________________

PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)

Current Address: _________________________________ City__________________ State______ Zip________

Month/Year Moved In______________________ Rent / Mortgage $__________
Reasons for Leaving__________________________________________________________________________
Owner/Agent ______________________________________________Phone ( ) ______________________
Previous Address (last 3 years)___________________________________Rent / Mortgage $________________
Owner/Agent______________________________________________ Phone ( ) ______________________

PLEASE DESCRIBE YOUR CREDIT HISTORY

Have you declared bankruptcy in the past seven (7) years? Yes [ ] No [ ]
If yes, explain ___________________________________________________________.
Have you ever been evicted from a rental residence? Yes [ ] No [ ]
If yes, explain ___________________________________________________________.
Have you had two or more late rental payments in the past year? Yes [ ] No [ ]
If yes, explain ___________________________________________________________.
Have you ever willfully or intentionally refused to pay rent when due? Yes [ ] No [ ]
If yes, explain ___________________________________________________________.
Have you ever been convicted of a crime, other than a traffic violation? Yes [ ] No [ ]
If yes, explain ___________________________________________________________.
Have you ever had a foreclosure / repossession? Yes [ ] No [ ]
Date _________f yes, explain ______________________________________________.

PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION

Your Status: _____Full Time _____Part Time _____Student _____Unemployed

Employer___________________________________________________________________________________
Dates employed_______________________________ Employed as___________________________________
Supervisor Name______________________________________________ Phone ( )___________________
Salary $_________________per________________. (If employed by above less than 12 months, give name &
phone of previous employer or school:___________________________________________________________.)
If you have other sources of income that you would like us to consider, please list income, source, and person
(banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or
spouse's annual income unless you want us to consider it in this application.
Amount $___________________ Source/Contact Name_____________________________________________

PLEASE LIST YOUR REFERENCES

Banking Accounts:
Bank Name_________________ Type of Account_________________ Account Number_________________
Approx. Balance $____________
Bank Name_________________ Type of Account_________________ Account Number_________________
Approx. Balance $____________
Other Active Credit References:
Institution Name______________ Type of Account_________________ Account Number_________________
Exp. Date ______________ Credit Limit $___________ How long _______ Are all payables current? ________
Other Active Credit Ref._________ Type of Account_________________ Account Number_________________
Exp. Date ______________ Credit Limit $___________ How long _______ Are all payables current? ________

Personal Reference or Emergency Contact:

Name _______________________ Address _______________________________________________
Phone _______________________ Relationship_______________________
Name _______________________ Address _______________________________________________
Phone _______________________ Relationship_______________________
Name _______________________ Address _______________________________________________
Phone _______________________ Relationship_______________________
Driver's License:
Your Driver's License Number____________________________ State_________________

Vehicle Information:
Make / Model _________________Year _________________License Plate State_________________
Make / Model _________________Year _________________License Plate State_________________
Make / Model _________________Year _________________License Plate State_________________

ADDITIONAL INFORMATION:
Please give any additional information that might help owner/management evaluate this application?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Where may we reach you to discuss this application?

Day Phone # ( ) ___________________________ Night Phone # ( )__________________________
Date of desired occupancy ______________________Anticipated length of stay ________________________
Do you own: Vacuum cleaner [ ] Lawn mower [ ] Waterbed [ ] Musical inst. [ ] Smoker Yes [ ] No [ ]
A non-refundable application fee of $__30_____ and a deposit of $_________ are required for processing this
application, and is being paid herewith. The undersigned expressly agrees that if this application is approved
applicant herewith agrees to rent this property. Applicant further agrees that if applicant is accepted by
Management or owner and then decides not to move into the premises, then all monies paid herewith shall be
retained as liquidated damages since other prospective tenants may have been turned away and it may be
necessary for Management or owner to re-advertise the property and evaluate other applicants. Processing of
application shall be as timely as possible and the results may be delivered via telephone, fax or mail. Once
approved, applicant agrees to pay the balance of funds and complete the paperwork within 48 hours, otherwise
management or owner will assume that applicant has decided to forfeit the reservation/earnest money payment
made herewith and will begin re-marketing the property. If applicant is not approved, all monies given herewith,
less application fee shown above shall be returned to the applicant. Upon acceptance, this deposit shall be
retained as part of the security deposit.
I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted in 3
business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When so
approved and accepted, I agree to execute a lease for ___________ months before possession is given and to
pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by
the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason
of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for
processing my application, an investigative consumer report may be prepared whereby information is obtained
through personal interviews with others with whom I may be acquainted. This inquiry includes information as to
my character, general reputation, personal characteristics and mode of living.

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and
agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of
the property and to the agent to accept this application. I warrant that all statements above set forth are true;
however, should any statement made above be a misrepresentation or not a true statement of facts, all of the
deposit will be retained to offset the agent's cost, time, and effort in processing my application.
A PHOTOSTATIC COPY OF MY DRIVER’S LICENSE OR PICTURE ID CARD, SOCIAL SECRUITY CARD,
LATEST PAY CHECK STUB(S) AND LAST YEAR’S W-2 (s) OR COPY OF LAST YEARS INCOME TAX RETURN
ARE ATTACHED TO THE APPLICATION ( ), OR WILL BE PROVIDED ( ). I declare that the application is
complete, true and correct and I herewith give my permission for anyone contacted to release the credit or
personal information of the undersigned applicant to Management or their authorized agents, at any time, for the
purposes of entering into and continuing to offer or collect on any agreement and/or credit extended. I further
authorize Management or their Authorized Agents to verify the application information including but not limited to
obtaining criminal records, contacting creditors, present or former landlords, employers and personal references,
whether listed or not, at the time of the application and at any time in the future, with regard to any agreement
entered into with Management. Any false information will constitute ground for rejection of the application, or
Management may at any time immediately terminate any agreement entered into in reliance upon misinformation
given on this application.
The above information, to the best of my knowledge, is true and correct.

Please sign: X__________________________________ __________________________________

Name of Applicant Date
Please sign: X__________________________________ __________________________________
Name of Co-Applicant Date

AUTHORIZATION
Release of Information
I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a
house from this owner/manager.

_____________________________________________
Name (please print)

X_______________________________________ __________________________
Signature Date

APPLICANT: PLEASE DO NOT WRITE BELOW (FOR OFFICE USE ONLY)

Deposit of $__________________ Received by ____________________________ Date_______________

OFFICE NOTES: