Lease Application
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Each occupant and co-applicant 18 years or older must submit a separate application.
Property Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Anticipated Move-In Date
Monthly Rent ($)
Security Deposit ($)
Initial Lease Term Requested (Months)
A. Applicant Identification
Applicant's Name (as listed on proof of identification)
Applicant's Former Last Name (if applicable)
Email
Mobile Ph.
Work Ph.
Home Ph.
Do you consent to receiving text messages?
Yes
No
Soc. Sec. No.
Driver License/ID No.
in (State)
Date of Birth
Month
Day
Year
Height
Weight
Eye Color
Hair Color
Are there co-applicants?
Yes
No
Note: If yes, each co-applicant must submit a separate application.
Co-applicant's name
Relationship
Co-applicant's name
Relationship
Co-applicant's name
Relationship
B. Property Condition
Has the applicant viewed the Property in-person prior to submitting any application?
Yes
No
Applicant is strongly encouraged to view the property in-person prior to submitting any application.
Landlord makes no express or implied warranties as to the Property's condition. Applicant requests Landlord consider the following repairs or treatments should Applicant and Landlord enter into a lease:
C. Representation and Marketing
Is Applicant represented by a REALTOR® or other agent?
Yes
No
If yes, Name
Company
Email
Phone Number
Applicant was made aware of Property via:
Sign
Internet
Other
Other
D. Applicant Information
Housing:
Applicant's Current Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Landlord or Property Manager's Name
First
Last
Email
Phone (Day)
Phone (Night)
Mobile
Fax
Move In Date
Month
Day
Year
Move Out Date
Month
Day
Year
Rent ($)
Reason for move
Applicant's Previous Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Landlord or Property Manager's Name
First
Last
Email
Phone (Day)
Phone (Night)
Mobile
Fax
Move Out Date
Month
Day
Year
Move In Date
Month
Day
Year
Rent ($)
Reason for move
Employment and Other Income:
Applicant's Current Employer
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Employment Verification Contact
First
Last
Phone
Fax
Email
Start Date
Month
Day
Year
Gross Monthly Income
Position
Note: If Applicant is self-employed, Landlord may require one or more previous year's tax return attested by a CPA, attorney, or other tax professional.
Applicant's Previous Employer
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Employment Verification Contact
First
Last
Phone
Fax
Email
Employed From
Month
Day
Year
Employed To
Month
Day
Year
Gross Monthly Income ($)
Position
Note: Applicant is responsible for including the appropriate contact information for employment verification purposes.
Describe other income Applicant wants considered:
Emergency Contact:
Emergency Contact Name
First
Last
Relationship
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
Email
E. Occupant Information:
Name all other persons that are not co-applicants who will occupy the Property.
Name
Relationship
Date of Birth
Month
Day
Year
Name
Relationship
Date of Birth
Month
Day
Year
Name
Relationship
Date of Birth
Month
Day
Year
F. Vehicle Information:
List all vehicles to be parked on the Property (cars, trucks, boats, trailers, motorcycles, other types of vehicles):
Type
Year
Make
Model
License Plate No./State
Monthly Payment ($)
Add
Remove
Note: State, local, and/or HOA ordinances may restrict your ability to park certain vehicles on the Property.
G. Animals:
Will any animals (dogs, cats, birds, reptiles, fish, other types of animals) be kept on the Property?
Yes
No
If yes, list all animals to be kept on the Property:
Type & Breed
Name
Color
Weight
Age in Years
Gender
Neutered Y/N?
Bite History Y/N?
Rabies/Shots Current Y/N?
Assistance Animal Y/N?
Add
Remove
Note: If any of the animals listed above are assistance animals, please provide appropriate documentation with a reasonable accommodation request for the assistance animal(s).
H. Additional Information:
Will any waterbeds or water-filled furniture be on the Property?
Yes
No
Does anyone who will occupy the Property smoke or vape?
Yes
No
Will Applicant maintain Renter's insurance?
Yes
No
Is Applicant or Applicant's spouse, even if separated, in military?
Yes
No
If yes, is the military person serving under orders limiting the military person's stay to one year or less?
Yes
No
Has Applicant ever been evicted?
Yes
No
Has Applicant ever been asked to move out by a landlord?
Yes
No
Has Applicant ever breached a lease or rental agreement?
Yes
No
Has Applicant ever filed for bankruptcy?
Yes
No
Has Applicant ever lost property in a foreclosure?
Yes
No
Has Applicant ever been convicted of a crime?
Yes
No
If yes, provide the location, year, and type of conviction:
Is any occupant a registered sex offender?
Yes
No
If yes, provide the location, year, and type of conviction:
Has Applicant had any credit problems, or slow-pays, or delinquencies?
Yes
No
If yes, please provide more information below:
Is there additional information the Applicant wants considered?
Yes
No
Please provide more information below:
I. Authorization:
Applicant authorizes Landlord and Landlord's authorized agent, at any time before, during, or after any tenancy, to:
(1) obtain a copy of Applicant's credit report;
(2) obtain a criminal background check related to Applicant and any occupant; and
(3) verify any rental or employment history or verify any other information related to this application with persons knowledgeable of such information.
Notice of Landlord's Right to Continue to Show the Property:
Unless Landlord and Applicant enter into a separate written agreement otherwise, the Property remains on the market until a lease is signed by all parties and Landlord may continue to show the Property to other prospective tenants and accept another offer.
Privacy Policy:
Landlord's agent or property manager maintains a privacy policy that is available upon request.
Fees:
Applicant submits the non-refundable fee shown below (entity or individual) for processing and reviewing this application.
Non-refundable fee from ($)
Non-refundable fee to ($)
Will the Applicant submit an application deposit to be applied to the security deposit upon execution of a lease or returned to Applicant if a lease is not executed?
Yes, the Applicant will submit an application deposit
No, the Applicant will not submit an application deposit
Please enter the application deposit amount ($):
Acknowledgement & Representation:
(1) Signing this application indicates that Applicant has had the opportunity to review Landlord's tenant selection criteria, which is available upon request. The tenant selection criteria may include factors such as criminal history, credit history, current income, and rental history.
(2) Applicant understands that providing inaccurate or incomplete information is grounds for rejection of this application and forfeiture of any application fee and may be grounds to declare Applicant in breach of any lease the Applicant may sign.
(3) Applicant represents that the statements in this application are true and complete.
(4) Applicant is responsible for any costs associated with obtaining information.
Applicant's Signature
*
Date
Month
Day
Year
AUTHORIZATION TO RELEASE INFORMATION RELATED TO A RESIDENTIAL LEASE APPLICANT
I,
First
Last
(Applicant), have submitted an application to lease a property located at:
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
The landlord, broker, or landlord's representative is:
Top of Texas Real Estate, LLC
219 E. 7th Street, P.O. Box 352
Dalhart, TX 79022
(806)244-6000
cyndi@topoftexasrealestate.com
I give my permission:
(1) to my current and former employers to release any information about my employment history and income history to the above-named person;
(2) to my current and former landlords to release any information about my rental history to the above-named person;
(3) to my current and former mortgage lenders on property that I own or have owned to release any information about my mortgage payment history to the above-named person;
(4) to my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to the above-named person; and
(5) to the above-named person to obtain a copy of my consumer report (credit report) from any consumer reporting agency and to obtain background information about me.
Applicant's Signature
*
Date
Month
Day
Year
Note: Any broker gathering information about an applicant acts under specific instructions to verify some or all of the information described in this authorization. The broker maintains a privacy policy which is available upon request.
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