Rental Application – Big Blue Building

Name

Rental address

Please list anyone that will occupy the unit, including yourself. Each person over the age of 18 occupying the unit must complete a separate application:

Self

Name

Phone

Email

Occupant 2

Name

Relationship to you

Occupant 3

Name

Relationship to you

Occupant 4

Name

Relationship to you

Occupant 5

Name

Relationship to you

Additional Occupants

Selected Value: 0

Residence

Current Address

Address Line 1

City

State

Zip Code

Last residence

Address Line 1

City

State

Zip Code

Landlord Name / Contact Info

Prior residence?

N/A
Yes

Employment

Current Employer name

Employer address

Last Employer name

Employer address

Position

Employed since

Position

Employed since

Supervisor or HR Name

Contact number

Supervisor or HR Name

Contact number

Prior Employer

N/A
Yes

Prior employer

Employer address

Position

Employed since

Supervisor or HR Name

Contact Info

Other Income

Do you receive income from other sources (unemployment, rental assistance, pension, etc.)? If Yes Describe below:

Yes
No

Number of sources

Selected Value: 1

Income source 1

Source of income

Amount received per month

Income source 2

Source of income

Amount received per month

Income source 3

Source of income

Amount received per month

Total monthly income from all sources: attach proof below:

File Upload

Click or drag a file to this area to upload.

Financial obligations (loans, credit cards, child support):

1st

Owed to

Description

Balance owed

Monthly payment

2nd

Owed to

Description

Balance owed

Monthly payment

3rd

Owed to

Description

Balance owed

Monthly payment

4th

Owed to

Description

Balance owed

Monthly payment

Total monthly obligations to all creditors:

Number of obligations

Selected Value: 0

Have you:

Filed a petition for bankruptcy in the past seven years?

YES
NO

Ever been a defendant in any legal proceeding connected with housing?

YES
NO

Ever been late paying rent or refused to pay any rent when due?

YES
NO

Ever received a notice to vacate, eviction notice, or court summons from any landlord?

YES
NO

Ever had a landlord claim that you damaged their property?

YES
NO

Been convicted of a felony in the last ten years?

YES
NO

Ever broken a rental agreement or lease?

YES
NO

Ever had a neighbor complain about you?

YES
NO

Ever been incarcerated for drugs, violent offenses, firearms, injury to persons, rape or sexual assault?

YES
NO

Current or creditors:

If you answered Yes to any of the items above please explain (attach additional notes if necessary):

Personal references (Do not include relatives. Neighbors, co-workers, or colleagues are preferred, but not those already listed on this application as employment or housing references):

1st reference

Name

Address

Phone

Relationship to applicant

2nd reference

Name

Address

Phone

Relationship to applicant

Do you smoke?

Yes
No

Do you plan to have any animals staying in your apartment?

How many vehicles do you plan to park at this location?

Affirmation

I certify that the information given above is true and correct and understand that the rental agreement may be terminated if I have made any material false or incomplete statements in this document. I authorize the property manager to contact all references listed to obtain information about me and to obtain a copy of credit, eviction and criminal reports. I further expressly authorize the references listed herein to release information to the property manager. A photocopy or electronic copy shall be valid as originals. If my application is denied based on my credit report, I will be informed of the specific reason. I understand that there is no agreement to rent until a rental agreement is signed by the property manager, all nessarary documents and information has been submitted and verified, all move-in funds have been paid, and the rental process is complete.

Signature (Print Name)

I AFFIRM THAT THE FOREGOING IS TRUE AND CORRECT UNDER THE PAINS AND PENALITIES OF PERJURY

I AGREE