LEASE APPLICATION
Instructions: A separate application must be filed out by each applicant. Completely fill out each blank
and sign where indicated.

APPLICANT _________________________________________________ DATE __________________
MARITAL STATUS: _______ SINGLE ________ MARRIED SINCE (DATE) ___________ DIVORCED
BIRTH DATE ___________ SS# ___________________ DRIVER'S LICENSE # ___________________
STATE ISSUED ________________ PHONE NUMBER#
ADDRESSES
PRESENT ADDRESS: ______________________________________________________SINCE______
WHY ARE YOU LEAVING? _____________________________________________________________
IS RENT UP TO DATE? ________________________________________________________________
ARE YOU BEING EVICTED? _________ WILL YOU GIVE A 30 DAY NOTICE? ________________
LANDLORD NAME AND PHONE # ______________________________________________________
PREVIOUS ADDRESS: ____________________________________________________SINCE______
WHY DID YOU LEAVE? _______________________________________________________________
WAS RENT UP TO DATE? ____________________________________________________________
WERE YOU BEING EVICTED? _________ DID YOU GIVE A 30 DAY NOTICE? ________________
LANDLORD NAME AND PHONE # ______________________________________________________
PREVIOUS ADDRESS: ____________________________________________________SINCE______
WHY DID YOU LEAVE? _______________________________________________________________
WAS RENT UP TO DATE? _____________________________________________________________
WERE YOU BEING EVICTED? _________ DID YOU GIVE A 30 DAY NOTICE? ________________
LANDLORD NAME AND PHONE # _______________________________________________________
PREVIOUS ADDRESS: ____________________________________________________SINCE______
WHY DID YOU LEAVE? _______________________________________________________________
WAS RENT UP TO DATE? _____________________________________________________________
WERE YOU BEING EVICTED? _________ DID YOU GIVE A 30 DAY NOTICE? ________________
LANDLORD NAME AND PHONE # _______________________________________________________
OCCUPANTS
NUMBER TO OCCUPY: __________ ADULTS ________ CHILDREN _________ PETS ___________
NAMES SS#'s RELATIONSHIPS BIRTH DATE____________________________________________​

____________________________________________________________________________________​

____________________________________________________________________________________

____________________________________________________________________________________

​​​​​​VEHICLES
​​MAKE / MODEL / COLOR ________________________________ LICENSE TAG # 1 _____________
STATE _____________ LIEN HOLDER ____________________________________________________
MAKE / MODEL / COLOR ________________________________ LICENSE TAG # 2 _____________
STATE _____________ LIEN HOLDER ____________________________________________________
MAKE / MODEL / COLOR ________________________________ LICENSE TAG # 3 _____________
STATE _____________ LIEN HOLDER ____________________________________________________





​​​​​EMPLOYMENT / INCOME
EMPLOYER __________________________________ EMPLOYER ___________________________
Street / City __________________________________ Street / City ____________________________
What do you do? ______________________________ What do you do? ________________________
Supervisor ____________________ ph # ____________ Supervisor _____________ ph # ____________
CURRENT INCOME PER MONTH:__________________________________ SOURCE ____________
CURRENT INCOME PER MONTH:__________________________________ SOURCE ____________
CURRENT INCOME PER MONTH:__________________________________ SOURCE ____________
BANK / CREDIT UNION ________________________________ ACCOUNT # _____________________
BANK / CREDIT UNION ________________________________ ACCOUNT # _____________________
NAME IN WHICH UTILITIES ARE NOW BILLED AND ACCOUNT # _____________________________
​NAME AND # ______________________________ NAME AND # ______________________________

REFERENCE NON-RELATIVE
NAME __________________________________________________ PHONE ____________________
NAME __________________________________________________ PHONE ____________________
NAME __________________________________________________ PHONE ____________________
NAME __________________________________________________ PHONE ____________________
EXPLAIN ANY "YES" ANSWERS ON THE BACK IF NECESSARY.
Has any signer ever been sued for bills? Yes No _________________________________________
Has any signer ever been bankrupt? Yes No _____________________________________________
Has any signer ever been sued for eviction? Yes No ________________________________________
Has any signer been guilty of a felony? Yes No ___________________________________________

Applicant authorizes the owner to contact past and present landlords, employers, creditors
credit bureau, neighbor, and any other sources deemed necessary to obtain reference
information on applicant.

All the information is, accurate and complete to the best of applicant's knowledge. Owner
reserves the right to disqualify tenant if information is not as represented by applicant.

ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDER-
SIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY
TIME.

NAME _________________________________________________ DATE __________________
APPLICANT
NAME _________________________________________________ DATE __________________
APPLICANT


 - Print off a copy (right click on the page and select Print)
 - Fill it out
 - Mail to  PO Box 796 Piketon, OH 45661​​ or fax to 740-941-1973