RentalApplication

IMPORTANT: • All adults, regardless of marital status, must fill out a separate application form.
Please fill out entire application, leave NO fields blank. Simply note any items which are not applicable.
EACH FIELD/OPTION MUST BE FILLED-IN/CHECKED-OFF! The form will not successfully submit unless you do...

Which rental unit would you like? *

* Indicates required field

APPLICANT'S INFORMATION:

NAME: *

First

Last

Tel #: *

Email: *

Current Mailing Address: STREET/PO BOX *

Current Mailing Address: CITY/STATE/ZIP *

Date of Birth: *

Social Security #: *

VEHICLE INFORMATION:

Vehicle: Yr/Make/Model/Color: *

License # / STATE: *

Plate # / STATE: *

COURT RECORD?

Convictions or charges ? *

If YES, please provide details: *

Passport #: (If foreign national) *

LANDLORD'S INFORMATION:

Landlord's Name & Address, Tel. & Email: *

How long at address? *

Landlord notified? *

Reason for moving: *

Prior Landlord: Name & Address, Tel. & Email: *

How long w/ prior Landlord? *

Comments to add? *

EMPLOYMENT / INCOME:

Employer Name & Work Address: *

Supervisor: Name, Tel. Number *

Position at work? *

Employed since when? *

Gross Monthly Income: *

Paid Weekly, Bi-Weekly or Monthly? *

Current monthly rent? *

Monthly util./car/cable, etc. bills? *

PERSONAL REFERENCES:

Relationship - Ref #1: *

Name, Address & Tel. - Ref #1: *

Relationship - Ref #2: *

Name, Address & Tel. - Ref #2: *

***NEXT OF KIN* *(In case of Emergency):***

Relationship - NOK #1: *

Name, Address & Tel. - NOK #1: *

Relationship - NOK #2: *

Name, Address & Tel. - NOK #2: *

PETS (Note: any pets, WILL limit your options.)

Pet #1- What? *

Pet #1- Name: *

Pet #1- Age: *

Pet #1-Spayed / Neutered? *

yes no

Pet #1-Declawed? *

yes no

Pet #1- Vet's name: *

Pet #1- License #: *

Pet #1 - Remarks: *

Pet #2- What? *

Pet #2- Name: *

Pet #2- Age: *

Pet #2- Spayed / Neutered? *

yes no

Pet #2- Declawed? *

yes no

Pet #2- Vet's name: *

Pet #2- License #: *

Pet #2- Remarks: *

I warrant that the information supplied is true and correct, and that I am at least 18 years of age. I have been informed that the owner is a member of the Credit Bureau Services of Vermont, and may check my credit with CBSV to evaluate my qualifications as a potential tenant; to evaluate my qualifications if the lease is to be renewed; and for rent collection purposes if required. Owner is allowed by contract with CBVS to report any rent delinquency, eviction, or for rent collection purposes. Owner further warrants that any information derived from credit reports or other sources will be kept confidential and not revealed to any third party.

I hereby acknowledge that false or incomplete information given in this Rental Application shall constitute grounds for rejection of this application, termination of any tenancy or occupancy created in whole or in part on false or incomplete information contained in this application, and may constitute criminal offense under the laws of this state.

I, the undersigned Applicant(s), have read and agree to all provisions of this Rental Application.

(My typed name will suffice for my digital signature.)

Comment *

Signature *

Date *

Submit

LANDLORD'S INFORMATION:

EMPLOYMENT / INCOME:

PERSONAL REFERENCES:

NEXT OF KIN (In case of Emergency):

PETS (Note: any pets, WILL limit your options.)

***NEXT OF KIN* *(In case of Emergency):***