RENTAL APPLICATION

This is an application to share a residency in a house that I own. It is in both our interests to make sure that you (and your living style) are compatible with the other residents of the house. In general, a quiet, drug-free, non-smoking environment is sought, along with cooperation in the maintenance of the public areas of the house.

Please answer the questions below as completely and accurately as possible.

Name (print) _______________________________________________ Age _______

Address ________________________________________Email _________________

______________________________________________ Phone ________________

Social Security #__________________ Driver's License #______________ State____

How long you've lived there ________________________ Rent $________/month

Landlord's name _________________________________ Phone ________________

Reason(s) for leaving ____________________________________________________

_______________________________________________ Have you given notice____

Names of housemates___________________________________________________

___________________________ Phone numbers ____________________________

Describe any other group living situations you've been in ________________________

_____________________________________________________________________

Do you have any pets ______________________________ Do you smoke ________

Employed by _____________________________________ Salary $_______ per ___

Address _________________________________________ Work phone __________

_____________________________________________________________________

Your job title ______________________________________ Job hours ___________

What is it you actually do _________________________________________________

_____________________________________________________________________

How long have you worked for this company _________________________________

Name of person you report to _____________________________________________

Title _____________________________________________ Phone ______________

Other sources of income _____________________________ $_________ per _____

Bank - checking account balance $_________________________________________

Bank - savings account balance $__________________________________________

Do you have a car ______ Make _____________ Model _____________ Year ____

What are your other fixed expenses (repaying loans, school, etc.) _________________

_____________________________________________________________________

Do you have any other commitments (school, second job, etc.) ___________________

_____________________________________________________________________

Spare time activities _____________________________________________________

Three References - names & phone numbers (preferably non-relatives you've known more than a year) (indicate whether work (W) or home (H) phones) _______________

__________________________________________________________________________________________________________________________________________

What are the earliest/latest dates you want to move in ____________/_____________

I certify that the above information is true, and authorize the checking of the sources named above.

Date ______________ Signature __________________________________________