Rental Application "*" indicates required fields Step 1 of 6 16% HOUSING PREFERENCE INFORMATION# BedroomsRent Range Preference# of Persons to Occupy Rental*# Over Age 18*Names of Individuals to Live There:*NameRelationshipAge Add RemoveAre you a US citizen?* Yes No Can you provide proof? Yes No # of Animals*Please enter a number from 0 to 999.Sorry, no more than 2 animals are allowedBreed of Animal Cat(s) Dog(s) Other Describe*Weight of Dog(s)*How Did You Hear About DF&C? HOME SEEKERS INFORMATIONHome Seekers Name First Middle Last AgeDOB MM slash DD slash YYYY Telephone (Home):*Telephone (Work):Telephone (Cellular):Email Social Security #Drivers License #Current Rent Amount*1) Present Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Present Landlord:Telephone:Is Landlord a Relative? Yes No # Years2) Former Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Landlord:Telephone:Is Landlord a Relative? Yes No # Years*Rent $3) Former Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Landlord Reference:TelephoneIs Landlord a Relative? Yes No # YearsRent $ LIST TWO RELATIVES WHO CAN BE CONTACTED IN CASE OF AN EMERGENCYNameAddressTelephoneRelationshipNameAddressTelephoneRelationship EMPLOYMENT RECORDName of Employer*Position*AddressTelephoneHow Long Employed in Years?Gross Income*Do you work:* F/T P/T Temp. Previous Employer (If Less Than 5 Years at Current)Telephone CREDIT INFORMATIONCredit CardsName of Credit CardMonthly Payment Amount Add RemoveAuto/Boat/Recreational Vehicle LoansNameMonthly Payment Amount Add RemoveMortgage LoansNameMonthly Payment Amount Add RemoveSecured/Unsecured LoansNameMonthly Payment Amount Add RemoveList Any Other Monthly ObligationsAny Credit Issues in Last 10 Years (including bankruptcy)* Yes No (if yes, explain)*Ever Been Past Due On a Bill or Rent* Yes No (if yes, explain)*Any Landlord Complaints in Last 10 Years* Yes No (if yes, explain)*Have You Ever Been Convicted of a Felony:* Yes No (if yes, explain)* DisclosureThe undersigned warrants that the only individuals who shall occupy rental, if accepted as tenants, shall be as indicated above. The undersigned further both jointly and severally, state, affirm represent, and warrant that the above information contained in this application for tenancy is true and correct.The undersigned hereby give the right to Donna Farrow & Company and any third party leasing service authorized by Donna Farrow & Company the right to inquire into or request information in regard to references, creditors, employers, past or present, and background information. Upon locating a property through Donna Farrow & Company, I authorize Donna Farrow & Company to order my credit report from the National Credit Check and agree to pay a $35.00 non-refundable fee for credit check. I agree to allow Donna Farrow & Company to provide owner of said property with a copy of my credit report and any relevant information.The undersigned acknowledges receipt of The Missouri Broker Disclosure pamphlet, explaining agency disclosure. Undersigned has been informed that Donna Farrow & Company elects to represent the Landlord.Date MM slash DD slash YYYY Applicants SignaturePhoneThis field is for validation purposes and should be left unchanged.
