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SOUTHSIDE BUNGALOW

APPLICATION FOR ROOM RENTAL

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Please fill out all information requested and bring the application with you to the house or email it back to me.  The application will NOT be considered unless it is filled out COMPLETELY.

 

NAME:                                                           SOC. SEC. #:                                     

 

DRIVERS LIC. #:                                                    DATE OF BIRTH                                 

 

ADDRESS:                                                                                                                            

                                                                                                            (city)                            (state)     (zip)

 

PHONE #S:  WORK                                       HOME                                                           

 

Car Make                                YR                   Model                          Plate#                         

 

WHAT IS THE DATE YOU WISH TO MOVE IN?                                                             

 

 

Housing Information

How long have you lived at current address?  From                to                                       

Rent Amount Paid:                                                                                                    

                                                                                                           

Name of Current Landlord:                                                 PHONE #:                              

 

What did you like about living at this residence?                                                                                                                                                                                                                 

 

What didn’t you like about living at this residence?                                                                                                                                                                                                             

 

How long at previous address?  From                                                to                                

 

Name of previous landlord:                                                    PHONE #:                              

 

Occupation Information

Current Employment:                                                                                                            

                                                (name of Company)                                         (dates from / to)

                                                                                                                                               

            (address)                                                                                                    (phone #)             

                                                                                                                                               

            (supervisors name )                                                                                    (monthly income)

 

 

Prior Employment:                                                                                                                 

                                                (name of Company)                                         (dates worked from/to)

                                                                                                                                               

            (address)                                                                                                    (phone #)             

                                                                                                                                               

            (supervisors name )                                                                                    (monthly income)

 

 


 

Credit References

 

Banks (list name of bank, address, phone #s, Account type: checking or savings)                                                                                                                                                                                                                                                                                                                                                                                                                                                               

 

Credit (list name of revolving accounts, credit cards, etc, address, phone #, type of account)                                                                                                                                                                                                                                                                                                                                                                                                                                               

 

History

  1. Have you ever filed a petition for bankruptcy?                 Y               N           
  2. Have you ever been evicted from a rental property?        Y               N           
  3. Have you ever been arrested?                                           Y               N           
  4. Have you ever been convicted of a crime?                       Y               N           
  5. Have you ever willingly withheld rent when due?            Y               N           

 

Give explanation of any yes answer above:                                                                                                                                                                                                                                                                                                                                                                          

 

Character References (list at least two UNRELATED people who can attest to your character – give relationship and phone number)                                                                                                                                                                                                                                                                                                                                                                  

                                                                                                                                               

 

I declare that the information given in this application is true, and that any misrepresentation by me will be grounds for terminating any future rental agreement entered into on the basis of this information.  I further give permission for the person or persons receiving this application to make contact with persons I have listed as references and verify any information herein provided.  I further give permission for a credit check to be made of my file in any credit bureau.  

 

Applicant Signature & Date                                                                                                                                                                                                                           

Print Name                                                                                                                                         

House Manager                                                                                                                      

                                    (signed)                                   (date)                          (time) 


 

 

Southside Richmond
E Broadrock Rd.
 
Questions or to make an appointment to see this great Bungalow, contact us at:
(703) 303-5103 or email