Room Rental Application Form
Applicant Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you smoke?
Yes
No
Are you a Convicted Felon?
Yes
No
Have you ever been Evicted?
Yes
No
Emergency Contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Current landlord Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Start Date
-
Month
-
Day
Year
Date
Monthly Date
Previous Landlord's Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Monthly Rent
$
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Employment
Company Name
Starting Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
Title
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Salary $
Monthly
Reference
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Notes
Proof of Employment/Income
ID Picture
Browse Files
Drag and drop files here
Choose a file
Driver's License, State ID, Passport, etc.
Cancel
of
Employment/Income Proof
Browse Files
Drag and drop files here
Choose a file
Employment Letter, Two Months Pay Stubs, etc.
Cancel
of
Full Credit Report
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Move-in Cost/ Payment Method
Are you able to pay four weeks or One Month's rent upfront?
Yes
No
Other
Are you able to pay a one-time, non-refundable, move-in/move-out/key set-up fee?
Yes
No
Other
What Payment Method do you plan to use?
Cash
Zelle
Venmo App
Square Cash App
Paypal
Google Pay
Other
Will you be able to stay for at least 6 months?
Yes
No
Other
Submit
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