RENTAL APPLICATION FOR: 6465 REYNOLDS RD MENTOR OHIO 44060
Name:________________________________________________________________
Address: ____________________________ City: ____________________________ State: _______ Zip: ________
Birth Date: _______________________ Social Security No: ________________ Home Phone: _________________
Years at Current Address:____________ Own: ___ Rent: ___
Landloard/Mortgage Holder Name: _________________________________________________________________
Address: ___________________________________________________________________________________
Landloard Phone Number: _______________________________
Previous Address: __________________________ City: _______________________ State: ______ Zip: _________
Years at Previous Address: ___________ How many persons depend on your financially? ____________
Nearest Relative Address: __________________________________ City: _______________ State: _____
Employer’s Name: ______________________________________________ Phone No: ____________________
Address: _______________________________ City: _____________________ State: ___________
Occupation: ____________________________________________ Years There: ________________
Income: ___________________________ Per Year: ___ Per Month: ___ Per Week: ___
Previous Employer Name: ________________________________________ Phone No: ____________________
Address: _______________________________ City: _____________________ State: ___________
Occupation: ____________________________________________ Years There: ________________
Income: ___________________________ Per Year: ___ Per Month: ___ Per Week: ___
Other Income Source: __________________________________________________________________________
Do you receive Social Security? ______ $ ___________ Pension? ___ $__________ Welfare? ___ $ __________
Bank Name: ______________________________________________________ Location: ___________________
Mortgage/Rent Payment: ________________________ Per Month: _____
Have you declared bankruptcy in the past 10 years. If yes, was it Chapter 7: ___ 11: ___ 13: ___
Have you had any garnishments, judgments, repossessions, or other legal actions in the past 7 years?: _______
Are you currently part in a lawsuit? _______ If yes, please explain on back.
Are you co-maker or co-signer on any other loans? ___ If yes, please explain on back
Provide Creditors Name that you owe money to.
Name:_______________________________________ Total: _________________ Monthly Payment: _________
Name:_______________________________________ Total: _________________ Monthly Payment: _________
Name:_______________________________________ Total: _________________ Monthly Payment: _________
Name:_______________________________________ Total: _________________ Monthly Payment: _________
Name:_______________________________________ Total: _________________ Monthly Payment: _________
Name:_______________________________________ Total: _________________ Monthly Payment: _________
No. in Family:________ Children and age:__________________________________________________________
Reference – Personal:
Name: _______________________________ Address:____________________________ City: ____________
Phone No: ____________________________________
Name: _______________________________ Address:____________________________ City: ____________
Phone No: ____________________________________
Name: _______________________________ Address:____________________________ City: ____________
Phone No: ____________________________________
Car Make _________ Car Model: _______________ Year: ________
Note: One year Contract required. No pets Permitted. This is a Non Smoking house.
Applicant agrees that above information is true and correct. Applicant authorizes an independent agent to conduct a credit audit on above supplied information. There is $30.00 fee for credit check payable to Wolfgang Kaufer.
Applicant Signature: ___________________________________________ Date: ______________________
