Name *

First Name

Last Name

Phone

(###)

###

####

Do you understand that smoking, vaping and all related activities are prohibited both inside the house and anywhere on the property? *

Yes

No

What date would you want to move in? *

MM

DD

YYYY

Do you think your current landlord would give you a good reference? *

Yes

No

I do not currently rent

Does your current landlord know you are planning to move out? *

Yes

No

I do not have a landlord at this time

Have you ever been evicted? *

Yes

No

Are there any issues we should know about before we run a background screening on you? *

Yes

No

I would not consent to a background check

Are you at least 19 years old? *

Yes

No

My parent / guardian will sign the lease

I will not disclose any information about my age at this time

Have you filed for bankruptcy in the last five years?

Yes

No

Are you willing to sign an annual lease agreement? *

No

Yes

Will you be able to pay the monthly rent, utilities and insurance for the house for the duration of the lease?

No

Yes

Will you be able to pay the security deposit of 50% of the monthly rent upon signing a lease? *

No

Yes