Rental Application

Property rental you are applying for

Desired Move-in Date

Applying as a tenant. (I will be living on the property.)Applying as a co-signer/guarantor for another applicant. (I will not be living on the property.)

Applicant Information

Number of occupants to occupy home:

Adults

Children

Primary Applicant
First Name

Last Name

Home Phone

Cell Phone

Email

Preferred method of contact:
HomeCellEmail

Date of Birth:
Social Security No.

Driver's License No.

Co-Applicant

First Name

Last Name

Home Phone

Cell Phone

Email

Preferred method of contact:
HomeCellEmail

Date of Birth:
Social Security No.

Driver's License No.

Additional Occupants Information

First Name

Last Name

Date of Birth:

First Name

Last Name

Date of Birth:

First Name

Last Name

Date of Birth:

First Name

Last Name

Date of Birth:

First Name

Last Name

Date of Birth:

Current Address

Address

City

State

Zip

Resided from (month/year)

Resided to (month/year)

Landlord's Name

Phone No.

Current rent payment

Reason for Moving

Does anyone in your household smoke?
YesNo

Please List Pets

First Pet's Name

Type of animal

Weight

Age

M/F

Neutered/Spayed

Second Pet's Name

Type of animal

Weight

Age

M/F

Neutered/Spayed

Third Pet's Name

Type of animal

Weight

Age

M/F

Neutered/Spayed

Prior Addresses

Prior Address 1:

Address

City

State

Zip

Resided from: Month/Year

Resided to: Month/Year

Landlord's Name

Phone No

Rent payment

Reason for moving

Prior Address 2:

Address

City

State

Zip

Resided from: Month/Year

Resided to: Month/Year

Landlord's Name

Phone No

Rent payment

Reason for moving

Prior Address 3:

Address

City

State

Zip

Resided from: Month/Year

Resided to: Month/Year

Landlord's Name

Phone No

Rent payment

Reason for moving

Vehicle Information

Vehicle 1:
Make

Model

Color

Year

License Plate Number

Vehicle 2:
Make

Model

Color

Year

License Plate Number

Vehicle 3:
Make

Model

Color

Year

License Plate Number

Employment Information

Primary Applicant’s Employer:

Employer Name

Employer Address

City

State

Zip

Position Held

Years worked

Supervisor's Name

Business Phone

Monthly Income

Co-Applicant’s Employer:
Employer Name

Employer Address

City

State

Zip

Position Held

Years worked

Supervisor's Name

Business Phone

Monthly Income

Other Sources of Income (monthly totals)

Tips

Government Cash Assistance

Child Support / Alimony

Other

Emergency Contact

Name

Address

Phone No.

Relationship

Personal References

Name

Address

Phone No.

Relationship

Name

Address

Phone No.

Relationship

Name

Address

Phone No.

Relationship

Bank information

Bank Name

Branch

Account Type

Have you ever been evicted from any rental premises?
YesNo

If yes, please explain:

Have you ever willfully and intentionally refused to pay rent when due?
YesNo

If yes, please explain:

Are there any circumstances which may interrupt your income or ability to pay rent?
YesNo

If yes, please explain:

Have you ever been convicted of a felony?
YesNo

If yes, please explain:

Are you required to be registered as a sex offender?
YesNo

If yes, please explain:

ANY ADULT, OTHER THAN A CO-APPLICANT, LIVING AT THE PREMISES, WILL NEED TO COMPLETE A SEPARATE RENTAL APPLICATION FORM.

Comments / Inquiries

Terms of Agreement

The Applicant understands that the Landlord may perform a credit check to verify the Applicant's credit references, credit history and order a criminal background check on Applicant in connection with processing this Rental Application.

I certify that my answers are true and correct and complete to the best of my knowledge. I understand that false or misleading information in my Application or required interview may result in an automatic rejection of my Application.

Mountain Valley Real Estate requires picture ID and Social Security Cards on all adults signing Rental Application.

By checking the boxes and clicking send below, you declare that all your statements in this application are true and complete. By submitting this application, you are directing and authorizing Mountain Valley Real Estate to verify this information and obtain additional background information about you through any means, including personal and professional references, employers and other rental housing owners.

You further direct and authorize Mountain Valley Real Estate to obtain from any law enforcement agency, present or past employer or supervisor, landlord, finance bureau/office, credit bureau, collection agency, college, university or other institute of learning or certification, private business, military branch or the national personnel records center, personal reference and/or other persons, and authorize the same to give records or information that they may have concerning your criminal history, motor vehicle/driving history, earnings history, credit history, character, general reputation, personal characteristics, mode of living, employment records, record of attendance and earned degrees or certificates, or any other information requested, whether the said records are private or public, and including those which may be deemed to be privileged or confidential in nature and you irrevocably and unconditionally release all such persons, including any named or unnamed informant, from any liability resulting from the furnishing of this information.

You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to tenants is an investigation into your prior rental history, education, and employment. You also acknowledge that our privacy policy is available to you.

Download the Terms of Agreement
Download the Fair Housing Guide for Renters and Home Buyers

By clicking send you are verifying that all information is complete and correct, and

You are authorizing Mountain Valley Real Estate to conduct the background check(s) described above.

You have received and read a copy of the Terms of Agreement and the Fair Housing Guide for Renters and Home Buyers shown above.