Rental Application
Complete the form and submit to apply for a rental property. Please note that all required fields (r) must be completed for the form to be submitted and accepted. If there is no answer for a question, please put a response, such as, "0", or "None", or "N/A", as appropriate. Please do not leave fields blank.
| Rental Property Applying For | ||||||||
| Rental Property Street Address | City | State | ||||||
| Applicant Information | ||||||||
| Last Name | First Name | Middle Name | ||||||
| Email Address | Social Security Number | Date of Birth | Phone Number | |||||
| Applicant Permanent Address or Home of Record | ||||||||
| Street Address | City | State | Zip Code | |||||
| Person to contact in case of emergency | ||||||||
| Full Name | Relationship | Address | Phone | |||||
| Occupants & Pets | ||||||||
| Names & Ages of all Intended Occupants | Number & Types of Pets | |||||||
| Applicant's Current Residence | ||||||||
| Street Address | City | State | Zip Code | |||||
| Landlord | Landlord's Phone | |||||||
| Applicant's Next Previous Residence | ||||||||
| Street Address | City | State | Zip Code | |||||
| Landlord | Landlord's Phone | |||||||
| Applicant's Next Previous Residence | ||||||||
| Street Address | City | State | Zip Code | |||||
| Landlord | Landlord's Phone | |||||||
| Applicant's Employment | ||||||||
| Employer | Length of Employment | Current Employer Address or Unit (Must be complete & accurate) | ||||||
| Employer's Phone | Supervisor/Manager | Supervisor's Phone | ||||||
| Position/Rank | App. Monthly Income | Other Income Sources | Other Income Total | |||||
| Co-Applicant Information | ||||||||
| Last Name | First Name | Middle Name | Date of Birth | |||||
| Social Security Number | Phone Number | Permanent Address or Home of Record | ||||||
| Employer | Length of Employment | Current Employer Address or Unit (Must be complete & accurate) | ||||||
| Employer's Phone | Supervisor/Manager | Supervisor's Phone | ||||||
| Position/Rank | App. Monthly Income | Other Income Sources | Other Income Total | |||||
| Applicant's & Co-Applicant's Combined Monthly Bills | ||||||||
| Vehicle Loan(s) | Mortgage | Insurance | Child Support | |||||
| Credit Card 1 | Credit Card 2 | Credit Card 3 | Mobile Phone(s) | |||||
| Student Loan Number 1 | Student Loan Number 2 | Allotments | Total All Other Bills | |||||
| Final Questions | ||||||||
| Ever Filed Bankruptcy? | If yes, what year? | Reason for Bankruptcy (If still paying, include in "Other" bills above) | ||||||
| Ever Been Evicted? | If yes, what year? | Reason for Eviction | ||||||
| Ever refused to pay rent? | If yes, reason for refusal | |||||||
Authorization
I authorize Holtzman Real Estate Services to pull a credit report using my/our Social Security Number(s), and to obtain any information needed to verify my rental history, including, but not limited to, a Rental Reference. Note: Your application cannot be processed without agreement.
Yes No You must agree in order to process your application...
Processing Application...please wait...
Thank you. Your rental application has been submitted and emailed to us. A copy of your application
has also been emailed to you.
Please review the information you provided and notify us of any corrections needed. Also, please let us know
if you do not receive your copy of your application in your email. We will review your application and contact you soon.
Holtzman Real Estate Services
I'm sorry, but there are errors in your application. Please review your form for any error messages, make needed corrections, and re-submit.