This application provides information about an applicant seeking to rent a property. It includes details about who would live there, contact and employment information for the applicant, their rental history including current and previous addresses and landlords, references, and answers to questions about paying rent on time, rental issues, and direct deposit preferences. The applicant signs to certify the truth of the information and permits credit and reference checks.

1. Application to rent _____________
Who would be living in the house:________________________________________________
____________________________________________________________________________
T#1: Name:_______________________________ Ph:_______________
Email:_____________________
SS#______________________________________ License #:__________________________
Recent Average Weekly Income: _______________________
I now pay _________/month for rent. I also pay about _____ for utilities.
Current Employer(s): ________________________Current job:_____________________
Name of Company Contact: ________________________ Title: _________________
Phone: _________________ email:_________________
Previous Employer: ___________________ Previous job: _____________________
Name of Company Contact: _____________________Title: _____________________
Address:______________ City: ______________ State: ___________ Zip: _______
Current Address: How long in same place?___________
Street: ______________ Apt #: ____City: ______________ State: ___________ Zip: _______
Your Current Landlord:_____________________________________________
Phone: _________________________________ email:__________________
Your Previous Address:
Street: ______________ Apt #: ____City: ______________ State: ___________ Zip: _______
Your Previous Landlord:_________________________________________________
Phone: _________________ email: ___________________
References (2 Personal references who know you well)
name:______________________________ Phone: __________________email:_______________
name:______________________________ Phone: __________________email:_______________
Questions:
1. Have you ever paid rent late? Yes/No Explain:
2. Do you have any issues in your rental history you would like to explain?:
3. We like to have direct deposit (from your bank account to ours) each month. Is that a problem?
Yes/no
4. Anything else you would like to share with us at this time?
I hereby certify that I am over 18 years of age and that the above application is true.
I also give the landlord or its agents permission check my credit and contact the above mentioned
references for the purpose of applying for the aforementioned apartment.
_______________________ _____________ ______________________________ ___________
(Applicant’s Signature(s) and date)
Sign and send this application to Andy Gustafson, 3126 Chicago St Omaha, NE 68131 (or email to
andygustafso@yahoo.com) (no ‘n’ on my email name) Thank you.