INDIANA RENTAL APPLICATION

First Name	Middle	Last	Birth Date	Social Security #	Driver’s License #	
						
Any Other Names You’ve Used In The Past	Home Phone	Cell Phone				
						
All Other Proposed Occupants	Birth Date	Relationship To Applicant				

						
						
RENTAL/RESIDENCE HISTORY
	Current Residence	Previous Residence	Prior Residence	
Street Address				
City				
State & Zip				
Last Rent Amount Paid				
Owner/Manager and Phone Number				
				
Reason for leaving				
Is/Was rent paid in full?				
Did you give notice?				
Were you asked to move?				
Name(s) in which your
utilities are now billed:				
	From/To	From/To	From/To	
Dates of Residency				
EMPLOYMENT HISTORY
	Current Employment	Previous Employment	Prior Employment	
Employed By				
Address				
Employer’s Phone				
Occupation				
Name of Supervisor				
Monthly Gross Pay				
	From/To	From/To	From/To	
Dates of Employment				
CREDIT HISTORY
	Bank/Institution Name	Balance On Deposit or Balance Owed	
Savings Account			
Checking Account			
Credit Card			
Auto Loan			
VEHICLES (Include vehicles belonging to other proposed occupants also)
Make	Model	Color	Year	License Plate	

REFERENCES & EMERGENCY CONTACTS
	Doctor	Lawyer	Nearest Relative Living Elsewhere	
Name				
Street Address				
City				
State & Zip				
Phone Number				
By signing the application you grant us permission to communicate with all the contacts listed in this section in the event we can’t locate you. Furthermore, if you abandon the apartment for any reason then you grant us permission to allow your relative listed above to remove all contents of the dwelling on your behalf.				
GENERAL INFORMATION
Have you ever been served a late rent notice?	Do any of the people who would be living in the apartment smoke?	How long do you think you would be renting from us?	
			
Have you ever filed for bankruptcy? If so, when?	When would you be able to move in?	Have you ever been convicted of a felony?	
			
Have you ever been served an eviction notice? If so, when?	How many pets do you have (list Type, Breed, approx Weight & Age)?		
			
Have you had any reoccurring problems with your current apartment or landlord? If yes, please explain:			
			
Why are you moving from your current address?			
			
List any verifiable sources and amounts of income you wish to have considered (optional):			
			
If you were to run into financial difficulty in the future and couldn’t come up with the money to pay the rent, do you know someone that would loan you the money? If so, provide the person’s name, address, & phone # so that we can use them as a reference for you.			
			
Have you been a party to a lawsuit in the past? If yes, please explain why:			
			
We may run a credit check and a criminal background check. Is there anything negative we will find that you want to comment on?			
			
How did you hear about this apartment?	Do you have an e-mail address we can reach you at?		
			
Do you know of anybody else looking for an apartment? Please provide their name and number. If you refer a friend and you each end up renting separate apartments from us then we will pay you a referral reward.			
			
 		Agreement & Authorization Signature	 The statements I have made are true and correct. I hereby authorize a credit and/or criminal check to be made, verification of information I provided and communication with any and all names listed on this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for an apartment and does not constitute a rental or lease agreement in whole or part. I further understand that there is a non-refundable fee to cover the cost of processing my application and I am not entitled to a refund even if I don’t get the apartment.

Signature: 	_____	Date:  	_____________

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