APPLICATION TO RENT
(All sections must be completed)
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Name: ____________________________________________________ Phone: ____________________________
Social Security #: ______________ Date of Birth __________________ Driver’s License and State: ______________
PROPERTY APPLYING FOR:
Address: __________________________________________Apt. # ___________ Rent Amt. __________ Per Month
How did you hear about this rental? _______________________________ Desired Move-in Date: _______________
Do you have pets? _____ (Y/N) Do you plan to use water filled furniture? _____ (Y/N)
LIST ALL INTENDED OCCUPANTS.
Name: ________________________ SSN#: ______________________________ Date of Birth: ________________
Name: ________________________ SSN#: ______________________________ Date of Birth: ________________
Name: ________________________ SSN#: ______________________________ Date of Birth: ________________
Name: ________________________ SSN#: ______________________________ Date of Birth: ________________
RENTAL HISTORY
Current
Address______________________________________________________________________________________
How Long: Start (mm/yy) ___________________ To: (mm/yy) _____________________ Rent Paid: ______________
To whom did you make rental payments: Name ___________________________ Phone:_______________________
Previous
Address______________________________________________________________________________________
How Long: Start (mm/yy) ___________________ To: (mm/yy) ____________________ Rent Paid: _______________
To whom did you make rental payments: Name ____________________________ Phone:_____________________
Second Previous
Address______________________________________________________________________________________
How Long: Start (mm/yy) ___________________ To: (mm/yy) ____________________ Rent Paid: _______________
To whom did you make rental payments: Name ____________________________ Phone:_____________________
EMPLOYMENT
CURRENT EMPLOYMENT
Company Name: ___________________ Address: ________________________________ Phone: ______________
Salary: ___________ Supervisor: ________________ Dates employed: ____________________________________
PREVIOUS EMPLOYMENT
Company Name: ___________________ Address: ________________________________ Phone: _____________
Salary: ____________ Supervisor: ______________ _ Dates employed: ____________________________________
CREDIT REFERENCES (Credit Cards/ Car Payments/Other Loans)
Company Name: ________________________________ Address/City _________________________________
Account # _____________________________ Present Balance ______________ Monthly Pmt. ______________
Company Name: ________________________________ Address/City _________________________________
Account # _____________________________ Present Balance ______________ Monthly Pmt. ______________
Company Name: _________________________________ Address/City _________________________________
Account # _____________________________ Present Balance ______________ Monthly Pmt. ______________
BANKING INFORMATION
Bank/S&L/Credit Union_____________________________ Checking Account # __________________________
Branch/Address___________________________________ Approximate Balance: ________________________
PERSONAL REFERENCES
Name: _________________ Address: ___________________ Phone: _______________ Relationship: ___________
Name: _________________ Address: ___________________ Phone: _______________ Relationship: ___________
EMERGENCY CONTACT
Name: _________________ Address: ___________________ Phone: _______________ Relationship: ___________
VEHICLES (Operable Vehicles Including Trucks, Van, Motorcycles)
Year: _____ Make: _________ Model: _______________ Color: _____________ License: ___________ State: ______
Year: _____ Make: _________ Model: _______________ Color: _____________ License: ___________ State: ______
ADDITIONAL INFORMATION
Have you ever had any credit problems? _____ (Y/N)
Have you ever had an unlawful detainer filed against you? _____ (Y/N)
Have you ever been evicted for non-payment of rent or any other reason? _____ (Y/N)
Have you ever filed for bankruptcy? _____ (Y/N)
Have you ever been convicted of a felony? _____ (Y/N)
If you answered yes to any of the above, please explain the circumstances on a separate sheet of paper.
Applicant represents that all of the above statements are true and correct and hereby authorized their verification including, but not limited
to, the obtaining of a credit report and agrees to furnish additional credit references on request. Owner/Agent is authorized to obtain a credit
report now and in the future.
In connection with my application for rental and/or employment, I understand that background inquiries may be made on myself including
consumer, criminal, driving, and other reports. Employment reports may include information as to my character, work habits, performance,
and experience along with reasons for termination of past employment from previous employers. I understand that information may be
requested from various federal, state, and other agencies and entities, public and private, which maintain records concerning my past
activities relating to driving, credit, criminal, civil, and other experiences as well as claims involving me in insurance company files.
I authorize, without reservation, any party or agency contacted, to furnish completely and without limitation, any and all of the above
mentioned information and any other information related thereto. Further, I will release from liability and will defend and hold harmless all
requesters and suppliers of information in accordance herewith.
The undersigned makes application to rent housing accommodations designated for the amount and location as set forth above and upon
approval of this application agrees to sign a rental or lease agreement and to pay all sums due, including requested deposits before
occupancy.
_________________________________________________________________
Applicant’s Signature Date
Each adult and student applicant must complete and sign a separate application. Completed and signed application forms may be faxed,
posted, dropped off, or scanned and emailed. Please see web site for further information.
REMCo – 2053 Forest Ave, #1 – Chico, CA 95928
Phone: (530) 892-0916 – Fax: (530) 903-4805
office@remco.us-- www.remco.us
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