Rental Application

Property applying for?:

Applicant Information

Last Name: *

First Name: *

Middle Name:

D.O.B.: *

S.S. #: *

Drivers License #:

Mobile Phone:

Work Phone:

Other Phone:

E-mail Address:

Roommate(s) (Full Names & D.O.B.):

Current Residence

Current Address: *

City: *

State: *

ZIP: *

Status:

Move in date:

Move out date:

Monthly Rent:

Landlord / Mortgage Co. Name:

City:

State:

ZIP:

Landlord Day Phone:

Landlord Evening Phone:

Reason for Vacating:

Have you given legal notice at your current residence?:

Previous Residence

Previous Address:

City:

State:

ZIP:

Status:

Move in date:

Move out date:

Monthly Rent:

Landlord / Mortgage Co. Name:

City:

State:

ZIP:

Landlord Day Phone:

Landlord Evening Phone:

Reason for Vacating:

Employment

Applicant Current Employer:

Position:

Telephone:

Supervisor Name:

Salary/Month:

Date of Hire:

Applicant Previous Employer:

Position:

Telephone:

Supervisor Name:

Salary/Month:

Date of Hire:

Additional Sources of Income:

Amount / Month:

Contact Name:

Contact Telephone:

Additional Information

Vehicle One Make:

Model:

Year:

Color:

State:

License #:

Vehicle Two Make:

Model:

Year:

Color:

State:

License #:

Will you be moving in any of the following:

Waterbed

Piano

Aquarium

Have you or any person who will occupy the unit ever been convicted, plead guilty, no-contest or have pending charges to a felony or misdemeanor?

Yes

If 'Yes', please describe:

Have you ever been evicted?:

Yes

If 'Yes', please explain:

Type / Size of Pets:

Do you have Renter's Insurance?:

Yes

Carrier:

Policy #:

Emergency Contact:

Relationship:

Address:

Telephone:

Use this space to elaborate on questions posed above or provide any other information relevant to your application for residency:

I certify that the above information is correct and complete and hereby authorize you to do a credit check and make any inquiries you feel necessary to evaluate my tenancy and credit standing. I understand that giving incomplete or false information is grounds for rejection of this application. If any information supplied on this application is later found to be false, ,this is grounds for termination of tenancy. Owner/Agent has charged a screening fee of $30.00. Applicant screening entails the checking of the applicants credit, rental history, employment history, public records and other criteria for residency. The applicant has the right to dispute the accuracy of any information provided to the owner/agent by the screening service or credit reporting agency. If the applicant is approved, applicants will have 48 hours from the time of notification to either execute a rental agreement and make all deposits required thereunder. If applicants fail to timely take the steps required above, they will be deemed to have refused the unit and the next application for the unit will be processed. Owner / Agent shall have no liability to applicant until such time as a rental agreement is signed by both parties.

Attention Electronic Filers: By checking the below box, typing your name and submitting this document electronically you are agreeing to the terms of this document and understand an executed electronic agreement is the same as a signature and is legally binding in the state of Oregon.

Do you agree to the terms stated herein?: *

Yes

Signed Applicant: *

Dated: *

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111 SW 5th Ave. Suite 3690 Portland, OR 97204 (503) 617-6414

Equal Housing Opportunity