First Name

Middle Name

Last Name

Social Security Number

Home Phone

Work Phone

Ext

Mobile Phone

Fax Number

Email Address

Co-Applicant First Name

Co-Applicant Middle Name

Co-Applicant Last Name

Social Security Number

Home Phone

Work Phone

Ext

Mobile Phone

Fax Number

Email Address

Current Address

Apt/Unit Number

City

State

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Zip

Own or Rent

Select... Own Rent

Manager/Landlord Name

Manager/Landlord Phone

Ext

Move In Date

Move Out Date

Current Monthly Rent

Reason for Move

Previous Address

Apt/Unit Number

City

State

Select a State... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Manager/Landlord Name

Manager/Landlord Phone

Ext

Move In Date

Move Out Date

Monthly Rent

Reason for Move

Pets

Select... Yes No

If yes, describe pets (male, female, breed, spayed/neutered, age)

Is your pet a Certified Service Animal? (Yes/No)

Self Employed

Select... Yes No

Employer

Address

City

State

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Zip

Date Hired

Position

Supervisor's Name

Employer Phone

Ext

Monthly Income before taxes

Spouse Self Employed

Select... Yes No

Employer

Address

City

State

Select a State... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Date Hired

Position

Supervisor's Name

Employer's Phone

Ext

Monthly Income before taxes

Other Source of Income

Monthly Amount

Person to Verify Amount

Telephone

Housing Assistance (Yes/No)

Housing Agent Name

DSS Assistance (Yes/No)

DSS Amount

Bank & Credit/Loan Data:

Bank Name

Branch

Savings Account Number

Checking Account Number

Firm Name 1

Branch

Amount $

Monthly Payment

Loan Type

Firm Name 2

Branch

Amount $

Monthly Payment

Loan Type

Please list all proposed occupants in addition to yourself and your spouse.

Name

Name 2

Name 3

Name 4

Name 5

Name 6

Please answer the following questions:

Have you or any occupant ever broken a lease?

Select... Yes No

If yes, date

If yes, details

Have you or any occupant ever convicted of a felony?

Select... Yes No

If yes, date

If yes, details

Do you smoke? (Yes/No)

Are you or any household member subject to a lifetime registration as a sex offender? (Yes/No)

If yes, list names:

Have you or any occupant ever removed from a rental by forcible action or any other legal action?

Select... Yes No

If yes, details

Personal References:

Name (Hawaii Resident)

Telephone

Name (Hawaii Resident)

Telephone

Name of nearest living relative

Relationship

Address

Telephone

In case of emergency, notify:

Relationship

Address

Telephone

Please enter the information of the property you wish to lease:

Address

City

Date you wish to occupy home

Agreement

By submitting this application, you are accepting the following terms. You are declaring that all of the information on this application is true and correct. You give the landlord the authority to verify all information and request a report from a credit reporting agency. Houses may be held for future occupancy with a deposit.

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