Henry Properties: Rental Application Form


Name: __________________________ S.S.#: ______-______-______
Birth Date: ____________________

Spouse: ________________________ S.S.#: ______-______-______
Birth Date: ____________________

Current Address: __________________________  City: ___________
State:_____   Zip:_________     Phone(s): _______________________
Current Landlord: __________________________________________
Phone: ___________________________    How Long: ____________

Previous Address: ___________________________  City: _________
State: _____   Zip: ____________
Previous Landlord: _________________________________________
Phone: ___________________________    How Long: _____________


Have you ever been evicted for unpaid rent? _____________________
For other reasons? __________________________________________

Do you currently owe any outstanding monies to previous landlords?
___________________________________________________________

Have you ever declared Bankruptcy? ___________________________
If yes, when? _______________________________________________

EMPLOYMENT INFORMATION:

Company where you work:___________________________________
Address: ________________________  Phone: __________________
How long? ________ Status: F.T. / P.T. / Contract
Job Title:________________  Supervisor: _______________________
Take Home Pay: ____________________________________________

Spouses Job: ___________________________________
Address: _________________________  Phone: __________________
How long? ________ Status: F.T. / P.T. / Contract
Job Title: __________________  Supervisor: _____________________
Take Home Pay: _____________________________________________

Other Sources/Amounts of Income: _____________________________

PERSONAL REFERENCES:

Name: _________________________________ Phone: ________________
Relationship: ___________________

Name: _________________________________ Phone: ________________
Relationship: ___________________

OTHER OCCUPANTS:

Name: ______________________________________ Age: _______
Relationship: _____________________

Name: ______________________________________ Age: _______
Relationship: _____________________

Name: ______________________________________ Age: _______
Relationship: _____________________

VEHICLES

Make: _______________________ Year: _______ Color: ____________
License Number: ________________ State: _______

Make: _______________________ Year: _______ Color: ____________
License Number: ________________ State: _______

I/We certify that the above information is correct and complete, and hereby authorize you to make any inquiries necessary to evaluate my tenancy and credit standing, including but not limited to credit checks. I/We agree to pay the $30.00 application fee, and understand that it pays the cost of my application regardless if I/We are approved, and is not credited toward any move in costs. Henry Properties shall not be responsible for any errors or problems relating to this verification process.

Applicant_______________________________________Date____________

Applicant_______________________________________Date____________