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Application
to Rent
I, the undersigned,
hereby apply to rent the property known as____________________
Louisville, Ky. for a period of _______ months from _______________ to
_______________ for which I agree to pay a monthly rate of $_________ in
advance on the first day of each and every month at the main office of
Roth Realty Co. Checks are payable to _______________________. I agree to
sign your regular lease form within seven (7) days and to pay the first
month's rent upon signing of lease. I have made a careful examination of
said premises and will accept said property in its present condition.
Applicant's Name______________________________
Birth date________________________
Social Security Number_________________________
Telephone No.___________________
Spouse's Name________________________________
Birth date________________________
Social Security Number_________________________
Birth date________________________
Name and Age of Everyone who will Occupy the Apartment
Present Address_______________________________________________
Zip__________
Landlord's Name________________________________ Telephone
No.______________
Landlord's Address_______________________________________________
Reason for Moving__________________________________
Rent Amount______________________ How Long?________________
Former Address_______________________________________________
Landlord's Name________________________________ Telephone
No.______________
Applicant's
Employer___________________________Supervisor__________________
Employer's Address____________________________
Telephone No.____________________
Position Held_________________ How Long?_____________
Salary______________per week (gross)
Spouse's Employer_____________________ Supervisor_______________________
Employer's Address____________________
Telephone No.____________________
Position Held_________________ How Long?_____________
Salary______________per week (gross)
Applicant's Previous Employer________________________ How
Long?______________
Other Income___________________________ per__________
source__________________
Name of Bank_______________________ Acct. No._________________ Ck___
Sav___
Personal References (Not employer or relative):
Name___________________ Address____________________________
Telephone No.__________
Name___________________ Address____________________________
Telephone No.__________
Credit References (Companies only; No individuals):
1.________________________ Bal._______________ Mo.
Payment________________
2.________________________ Bal._______________ Mo.
Payment________________
3.________________________ Bal._______________ Mo.
Payment________________
Do you own real estate?___________ Title in whose name?__________________
Location_____________________________ Monthly Mortgage
payments_________________
Vehicles - Vehicles not approved may be towed at owner's expense.
Make______________ Model_______________ Year_____ Color________ Lic.
No.__________ State________
Make______________ Model_______________ Year_____ Color________ Lic.
No.__________ State________
Has applicant, spouse, or any other proposed tenant ever:
Filed for bankruptcy?_____________ Been evicted?__________
Reason___________________
Willfully or intentionally refused to pay rent when
due?_________________________
Been a party to a lawsuit?__________ If so,
explain________________________________________
Nearest Relative &
Address______________________________________________________________
In emergency Notify_____________________________________
Pets: Number_____ Type___________________ Weight_______ Age_______
Housebroken______
I selected this community because:
Newspaper ad____ Sign____ Drive by____ Apt. Magazine____ Referred
by_____________
I acknowledge the facts above to be true to the best of my knowledge, and
it is understood that the foregoing instrument is to form a part of the
regular lease being executed for _________ months. Material
misrepresentations on this application will constitute a default under
the lease or rental agreement and Lessor may cancel said lease at his option
without giving notice in writing to lessee.
Applicant hereby authorizes verification of any and all information set
forth in this application, including release of information by any bank,
savings and loan, employer (present and former), and any credit checking
as may be necessary. All such information heron and released as
authorized above, will be kept confidential.
CREDIT CHECK CHARGE - Applicant has submitted the sum of $20.00, which is
a non-refundable payment for a credit check and processing charge. Such a
sum is not a rental payment or deposit amount. In the event this
application is approved or disapproved, this sum will be retained by
management to cover the cost of processing the application as furnished
by applicant. This application must be signed before it can be
processed by management.
SECURITY DEPOSIT – I hereby deposit $_____________________
with management in good faith in connection with this rental. If my
application is accepted, I understand this deposit will be retained. If,
for any reason, management declines my application, this deposit will be
refunded to me in full within thirty (30) days. Should I cancel or fail
to execute said lease, I understand that I will forfeit my deposit as
liquidated damages in payment for agent’s time and effort in
processing my inquiry and application.
If applicant has questions regarding qualification for rental acceptance
please call 895-4880. On site managers do not qualify prospective
residents.
Applicant's Signature:_____________________________
Date:_________________
Applicant's Signature:_____________________________
Date:_________________
Application and Deposit of $___________ received by:______________
Date received:______________
Co-applicants must file separate applications.
I have examined Apt. ____________ and have found no damage that will
affect the security deposit accept as noted below:
SEE MOVE-IN INSPECTION
_______________________________________
_______________________________________
_______________________________________
Tenant
For use by Roth Realty Company
Approved By:___________________________ Date:_________________
Denied By:_____________________________ Date:_________________
Please mail this application to Roth Realty with the $20.00
application fee and $__________ security deposit enclosed.
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