Rental Application
All answers must be typed, bold and underlined
Email a copy to a_jax2020@hotmail.com and
Mail signed copy to PO Box 1703 Logandale, NV 89021


Today’s Date________________________Date of anticipated move in Sept 3rd, 2007
Property Address 3155 Hidden Valley Dr #204, St George, UT 84790_____________
Monthly Rent $1,000_ Security Deposit $900

Applicant
Full Name of Applicant:
Present Address:
Telephone Number (Home): (Work):
D.O.B. Social Security #: Driver’s License #:
Religious Preference:
Do You Smoke:
Are you interested in a rent to own?
If Yes, please explain

Applicant’s Employment
Name of Present Employer:
Address:
Position: Date Started: Monthly Income:
Supervisor’s Name: Phone:
Name of Previous Employer:
Address:
Position: Date Started: Monthly Income:
Supervisor’s Name: Phone:
Other Sources of Income:

Spouse
Full Name of Spouse:
Present Address:
Telephone Number (Home): (Work):
D.O.B. Social Security #: Driver’s License #:
Religious Preference:
Do You Smoke:

Spouse’s Employment
Name of Present Employer:
Address:
Position: Date Started: Monthly Income:
Supervisor’s Name: Phone:
Name of Previous Employer:
Address:
Position: Date Started: Monthly Income:
Supervisor’s Name: Phone:
Other Sources of Income:

Present Landlord or Mortgage Company
Present Landlord/Mortgage Co:
Telephone Number:
Present Address:
Monthly Rent/Mortgage Payment: Length of Occupancy:
Reason for Leaving:

Previous Landlord or Mortgage Company
Present Landlord/Mortgage Co:
Telephone Number:
Present Address:
Monthly Rent/Mortgage Payment: Length of Occupancy:
Reason for Leaving:

Personal References (Must be non-relative references)
1)Name: Phone: Address:
2)Name: Phone: Address:
3)Name: Phone: Address:

Emergency Contact
Emergency Contact:
Relationship: Phone:

Occupants
List any occupant that will be or might be living with you
Name: Relationship: Age: Smoke:
Name: Relationship: Age: Smoke:
Name: Relationship: Age: Smoke:
Name: Relationship: Age: Smoke:
Name: Relationship: Age: Smoke:
Name: Relationship: Age: Smoke:

Pets
Pet Type: Breed: Weight: Age: Does it have all up to date shots:
Pet Type: Breed: Weight: Age: Does it have all up to date shots:

Vehicle Information

Make Model Year Color License Plate # State Payments






Credit/Criminal History
Bank Name:
Address:
List all credit obligations with minimum monthly payment:
Have you/any occupant declared bankruptcy in the past 7 years?
If Yes please explain
Have you/any occupant been evicted from a rental residence?
If Yes please explain
Have you/any occupant had two or more late rental payments in the past year?
If Yes please explain
Have you/any occupant ever willingly or intentionally refused to pay rent when due?
If Yes please explain
Have you/any occupant been convicted of a crime, other than a traffic violation?
If Yes please explain
We may run a credit check. Is there anything negative that we will find that you want to comment on?
If Yes please explain

The above listed applicant declares that all statements made in this application are true and complete. Applicant hereby authorizes Owner of above rental to verify all of the information in this application and obtain any and all credit reports on the applicant(s) listed above. If applicant or applicant’s spouse has given any false information the Owner of the Hidden Valley Heights rental property is entitled to reject the application.

Signature of applicant____________________________________Date______________

Signature of Spouse_____________________________________Date______________

Signature of Owner_____________________________________Date_______________