Primary Applicant

Last Name First Name

Middle Initial Social Security Number

Date of Birth (MM/DD/YYYY)

Secondary Applicant

Last Name First Name

Middle Initial Social Security Number

Date of Birth (MM/DD/YYYY)

Additional Number of People to Occupy Rental Unit
(Not to Include infants under the age of two)

Name DOB (MM/DD/YYYY)

Relationship Social Security Number

Name DOB (MM/DD/YYYY)

Relationship Social Security Number

Name DOB (MM/DD/YYYY)

Relationship Social Security Number

Primary Applicant

Current Address

City State Zip Code

Phone (Day) (Eve)

Rent

Move-in Date (MM/DD/YYYY)

Landlord Name

Landlord Business Number

Landlord Home Phone Number

Previous Address

City State Zip Code

Phone (Day) (Eve)

Rent

Move-in Date Move-out Date (MM/DD/YYYY)

Landlord Name

Landlord Business Number

Landlord Home Phone Number

Make of Car Color Year

License No.

Make of Car Color Year

License No.

Current Employer

Address

Position Salary

Dates Employed

Contact Phone

Previous Employer

Address

Position Salary

Dates Employed

Contact Phone

Spouse Current Employer

Address

Position Salary

Dates Employed

Contact Phone

Previous Employer

Address

Position Salary

Dates Employed

Contact Phone

Personal References

Name Phone

Name Phone

In Case of Emergency

Name Phone

Have you ever been convicted of a crime?

Yes

No

Comments

If you are a person with a disability and need for a reasonable accommodation, contact the manager.

I / We hereby certify that the above information is true and correct, and authorize verification of all information provided. I / We understand that a consumer credit report and criminal background check will be obtained. I / We agree that no other person, except those named above and approved, will occupy the rental unit at any time without prior written consent of the Lessor. I / We further agree that all adults residing in the rental unit are jointly and severely liable for all rent and lease obligations. The undersigned, on the basis of the above information, makes application to rent:

Unit N o. Located at

for a Rental Amount of $ Per Month

Electronic Signature

I understand that by submitting this rental application electronically that I am consenting and do here by consent to Verity Property Management using the information in this application to run my credit, criminal, background, and rental history.

Submitting this form shall constitute my electronic signature authorizing Verity Property Management and any credit, criminal, or background reporting agency to rely upon this electronic signature.

Please check this box confirming you have read the Electronic Signature consent release and type your name in the box before submition.

A DEPOSIT PAID BY THE APPLICANT IS REFUNDABLE ONLY IF APPLICANT IS NOT APPROVED; NON-REFUNDABLE IF APPLICANT IS APPROVED BUT FAILS TO TAKE OCCUPANCY OF THE RENTAL UNIT.

Submit Application

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***Please Note: After application submition you will directed to PayLease were you will be able to pay your $20 application fee per applicant over the age of 18. Your application will not be processed until this fee has been paid.***