Rental Leasing Client Intake

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Current Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Date of Birth

Date

Employment Status

Monthly Income (USD)

Intended Move-In Date

Date

Number of Occupants

Do you have any pets?

Yes, other

Previous Rental Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Landlord/Property Manager Reference (Name & Contact)

Personal Reference (Name & Contact)

Have you ever been evicted or broken a lease?

If yes, please provide details

Signature