Rental Form

Rental Application Date:

Address:

PRIMARY APPLICANT

Name:
DOB:
SSN:
CAR:
Phone:
Email:
Employer:
Employer Address:
Employer Phone Number:
Rank:
ETS Date:
How long?
Supervisor:
NET Monthly Income:
Other Source of Income:
Pets:
# of Kids:

CO-APPLICANT

Name:
DOB:
SSN:
CAR:
Phone:
Email:
Employer:
Employer Address:
Employer Phone Number:
Rank:
ETS Date:
How long?
Supervisor:
NET Monthly Income:
Other Source of Income:
Pets:
# of Kids:

References

1. Personal Reference Name:
Phone Number:
Personal Reference Address:
2. Personal Reference Name:
Phone Number:
Personal Reference Address:

Resident History

Present Address:
Present Landlord Name:
Present Landlord Number:
Reason for Moving:
How Long:
Amount Paid:
Permanent Address
How did you hear about Junghans Agency?
Have you ever filed bankruptcy or had a judgement against you?
If YES, please explain:
Have you or any Household Member been convicted of a felony or drug charge within the last 5 years?
If YES, please Specify Conviction:
I/WE certify that the above information is correct and I understand that this request may be denied if any information is found
to be incorrect. I/WE authorize you to contact any references, landlords, credit bureaus or law enforcement authorities.
I understand that a copy of my/our Drivers License will be copied and kept in file.
Applicant Signature
Co-Applicant Signature
Date:

Date: