Samir Properties Rental Application

 

Please complete all information below. ALL applicants 18 and older MUST complete and sign their own application.

Applicant Full Name: _________________________________________________ Phone#: _______________________

Social Security #: ____________________ Driver’s License #: _______________________ DOB: __________________

Current Address: _________________________________ City/State: _____________________ Zip: ______________

Current Landlord Name: ___________________________________ Landlord Phone #: _________________________

How long at this address: _______________ Reason for leaving: ____________________________________________

Previous Address: _____________________________ City/State: _______________________ Zip: ________________

How long at this address: _____________ Reason for leaving: ______________________________________________

Present Employer: _______________________________________ Postion: ___________________________________

Monthly Income: _______________________ Phone #: ______________________ How long at job: _______________

Employers Address: _____________________________________City/State: ___________________ Zip: ____________

Number & type of pet(s): ____________________ Have you EVER been evicted: ( ) Yes or ( ) No

Name of Bank: _______________________ Branch Location: _______________ Acct. Type: __________

Professional References:

Name: ________________________ Yrs. Known: _______ Relationship: ____________ Phone #: __________________

Name: ________________________ Yrs. Known: _______ Relationship: ____________ Phone #: ___________________

Name: ________________________ Yrs. Known: _______ Relationship: ____________ Phone #: __________________

Total number of Adults _______ Total number of children living with you under the age of 18 _________

Name(s) and relationship of all applicants:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for tenant screening as may be necessary in arriving at a decision of approval or denial. I understand that the landlord may terminate any rental agreement entered into for any misrepresentation mad above.

Signature: _______________________________________________________ Date: _____________________

For Office Use ONLY

Address Wanted: ___________________________________ Apt Size: ______________ Date Submitted: ______________

Approved Date: _________________________ Deposit Required: ________________ Date Denied: ___________________


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