Residential Lease Application – CoordinateThat.com

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Email*

Property Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Move-in Date:

Monthly Rent:

Security Deposit:

Initial Lease Term Requested

(months)

Property Condition: Applicant ___ viewed the Property in-person prior to submitting this application.*

Has

Has not

Applicant is strongly encouraged to view the Property in-person prior to submitting any application.
Landlord makes no express or implied warranties as to the Property’s condition. Applicant requests Landlord consider the following repairs or treatments should Applicant and Landlord enter into a lease:

Repairs you feel need to done

Applicant was referred to Landlord by:*

Real Estate agent

Newspaper

Sign

Internet

Other

Real Estate Agent Name*

First Last

Email (Realtor)*

Phone

Other

Applicant Information

Name:*

First Middle Last

Do you have a former last name?*

Yes

Applicant's former last name*

Last

Email:*

Phone*

Social Security No.*

Drivers License No.

State

Date of Birth*

Height

Weight

lbs

Eye Color

Hair Color

Marital Status*

Is there a co-applicant?*

Yes

Co-applicant must submit a separate application

Emergency Contact

Do not insert the name of an occupant or co-applicant.

Name

First Last

Relationship

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Landlord or Property Manager's Name

First Last

Phone

Date Move -In:

Move-Out Date:

Rent:

Reason for move:

Previous Resident

Previous Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Landlord or Property Manager Name:

First Last

Email:

Phone

Date Move-In:

Move-Out Date:

Rent

Reason for move:

Employer Info

Applicants Current Employer:

Current Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Verification Contact

First Last

Phone

Start Date:

Position

Gross Monthly Income

Applicant's Previous Employer

Previous Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Verification Contact

First Last

Phone

Start Date

End Date

Position

Gross Monthly Income

Describe other income Applicant wants considered

Vehicles

Do you own a Vehicle?*

Yes

Number of Vehicles

Vehicle 1

Type

Year

Make

Model

License/State

Month Repayment:

Vehicle 2

Type

Year

Make

Model

License/State

Month Repayment:

Vehicle 3

Type

Year

Make

Model

License/State

Month Repayment:

PETS

Do you have pets*

Yes

Number of Pets

Pet 1

Type & Breed

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Pet 2

Type

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Pet 3

Type & Breed

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Pet 4

Type

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Other information

Will any waterbeds or water-filled furniture be on the Property?*

Yes

Does anyone who will occupy the Property smoke?*

Yes

Will Applicant maintain renter’s insurance?*

Yes

Is Applicant or Applicant's spouse, even if separated, in military?*

Yes

Does is the military person serving under orders limiting the military person's stay to one*

Yes

Has Applicant ever:

been evicted?*

Yes

been asked to move out by a landlord?*

Yes

breached a lease or rental agreement?*

Yes

filled for bankruptcy?*

Yes

lost property in foreclosure?*

Yes

had any credit problems (including any outstanding debt (e.g., student loans or medical bills)), slow-pays or delinquencies?*

Yes

Please provide more information in the additonal comments.

been convicted of a crime?*

Yes

Please provide the location, year, and type of conviction in the additional comments.

Is any occupant a registered sex offender?*

Yes

Please provide the location, year, and type of conviction in the additonal comments.

Is there additional information Applicants wants considered?*

Yes

Additional Comments*

Authorization: Applicant authorizes Landlord and Landlord’s agent, at any time before, during, or after any tenancy, to:

obtain a copy of Applicant’s credit report;
obtain a criminal background check related to Applicant and any occupant; and
verify any rental or employment history or verify any other information related to this application with persons knowledgeable of such information.

Notice of Landlord’s Right to Continue to Show the Property: Unless Landlord and Applicant enter into a separate written agreement otherwise, the Property remains on the market until a lease is signed by all parties and Landlord may continue to show the Property to other prospective tenants and accept another offer.
Privacy Policy: Landlord’s agent or property manager maintains a privacy policy that is available upon request.
Fees: Applicant must a non-refundable fee of to (entity or individual) for processing and reviewing this application.

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Non-Refundable Fee

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Entity or Individual Name

Applicant ____ an application deposit*

Will submit

Will not submit

Deposit*

to be applied to the security deposit upon execution of a lease or returned to Applicant if a lease is not executed.

Acknowledgement & Representation:

Signing this application indicates that Applicant has had the opportunity to review Landlord’s tenant selection criteria, which is available upon request. The tenant selection criteria may include factors such as criminal history, credit history, current income and rental history.
Applicant understands that providing inaccurate or incomplete information is grounds for rejection of this application and forfeiture of any application fee and may be grounds to declare Applicant in breach of any lease the Applicant may sign.
Applicant represents that the statements in this application are true and complete.
Applicant is responsible for any costs associated with obtaining information.

Acknowledgement & Representation

Legal Consent*

I agree to the terms and conditions.

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices.

“Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address.

“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

Signature

Date Signed*

Applicant*

First Last

, have submited an application to lease a property located at

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The landlord, broker, or landlord’s representative is:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

I give my permission:

to my current and former employers to release any information about my employment history and income history to the above-named person;
to my current and former landlords to release any information about my rental history to the above-named person;
to my current and former mortgage lenders on property that I own or have owned to release any information about my mortgage payment history to the above-named person;
to my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to the above-named person; and
to the above-named person to obtain a copy of my consumer report (credit report) from any consumer reporting agency and to obtain background information about me.

Signature*

Date*

Note: Any broker gathering information about an applicant acts under specific instructions to verify some or all of the information described in this authorization. The broker maintains a privacy policy which is available upon request.

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TENANT: Residential Lease Application

The purpose of this form is to gather the required information to complete this document in preparation for an offer.

"*" indicates required fields

Step 1 of 9

11%

This field is for validation purposes and should be left unchanged.

This field is hidden when viewing the form

dynamic populate email

This field is hidden when viewing the form

Email*

Property Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Move-in Date:

Monthly Rent:

Security Deposit:

Initial Lease Term Requested

(months)

Property Condition: Applicant ___ viewed the Property in-person prior to submitting this application.*

Has

Has not

Repairs you feel need to done

Applicant was referred to Landlord by:*

Real Estate agent

Newspaper

Sign

Internet

Other

Real Estate Agent Name*

First Last

Email (Realtor)*

Phone

Other

Applicant Information

Name:*

First Middle Last

Do you have a former last name?*

Yes

Applicant's former last name*

Last

Email:*

Phone*

Social Security No.*

Drivers License No.

State

Date of Birth*

Height

Weight

lbs

Eye Color

Hair Color

Marital Status*

Is there a co-applicant?*

Yes

Co-applicant must submit a separate application

Emergency Contact

Do not insert the name of an occupant or co-applicant.

Name

First Last

Relationship

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Landlord or Property Manager's Name

First Last

Phone

Date Move -In:

Move-Out Date:

Rent:

Reason for move:

Previous Resident

Previous Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Landlord or Property Manager Name:

First Last

Email:

Phone

Date Move-In:

Move-Out Date:

Rent

Reason for move:

Employer Info

Applicants Current Employer:

Current Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Verification Contact

First Last

Phone

Start Date:

Position

Gross Monthly Income

Applicant's Previous Employer

Previous Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Verification Contact

First Last

Phone

Start Date

End Date

Position

Gross Monthly Income

Describe other income Applicant wants considered

Vehicles

Do you own a Vehicle?*

Yes

Number of Vehicles

Vehicle 1

Type

Year

Make

Model

License/State

Month Repayment:

Vehicle 2

Type

Year

Make

Model

License/State

Month Repayment:

Vehicle 3

Type

Year

Make

Model

License/State

Month Repayment:

PETS

Do you have pets*

Yes

Number of Pets

Pet 1

Type & Breed

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Pet 2

Type

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Pet 3

Type & Breed

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Pet 4

Type

Name

Color

Weight

Age in Years

Gender

Female

Male

Neutered?

Yes

Bite History?

Yes

Rabies Shots Current?

Yes

Assistance Animal?

Yes

Other information

Will any waterbeds or water-filled furniture be on the Property?*

Yes

Does anyone who will occupy the Property smoke?*

Yes

Will Applicant maintain renter’s insurance?*

Yes

Is Applicant or Applicant's spouse, even if separated, in military?*

Yes

Does is the military person serving under orders limiting the military person's stay to one*

Yes

Has Applicant ever:

been evicted?*

Yes

been asked to move out by a landlord?*

Yes

breached a lease or rental agreement?*

Yes

filled for bankruptcy?*

Yes

lost property in foreclosure?*

Yes

had any credit problems (including any outstanding debt (e.g., student loans or medical bills)), slow-pays or delinquencies?*

Yes

Please provide more information in the additonal comments.

been convicted of a crime?*

Yes

Please provide the location, year, and type of conviction in the additional comments.

Is any occupant a registered sex offender?*

Yes

Please provide the location, year, and type of conviction in the additonal comments.

Is there additional information Applicants wants considered?*

Yes

Additional Comments*

Authorization: Applicant authorizes Landlord and Landlord’s agent, at any time before, during, or after any tenancy, to:

obtain a copy of Applicant’s credit report;
obtain a criminal background check related to Applicant and any occupant; and
verify any rental or employment history or verify any other information related to this application with persons knowledgeable of such information.

This field is hidden when viewing the form

Non-Refundable Fee

This field is hidden when viewing the form

Entity or Individual Name

Applicant ____ an application deposit*

Will submit

Will not submit

Deposit*

to be applied to the security deposit upon execution of a lease or returned to Applicant if a lease is not executed.

Acknowledgement & Representation:

Signing this application indicates that Applicant has had the opportunity to review Landlord’s tenant selection criteria, which is available upon request. The tenant selection criteria may include factors such as criminal history, credit history, current income and rental history.
Applicant understands that providing inaccurate or incomplete information is grounds for rejection of this application and forfeiture of any application fee and may be grounds to declare Applicant in breach of any lease the Applicant may sign.
Applicant represents that the statements in this application are true and complete.
Applicant is responsible for any costs associated with obtaining information.

Acknowledgement & Representation

Legal Consent*

I agree to the terms and conditions.

Signature

Date Signed*

Applicant*

First Last

, have submited an application to lease a property located at

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The landlord, broker, or landlord’s representative is:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

I give my permission:

to my current and former employers to release any information about my employment history and income history to the above-named person;
to my current and former landlords to release any information about my rental history to the above-named person;
to my current and former mortgage lenders on property that I own or have owned to release any information about my mortgage payment history to the above-named person;
to my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to the above-named person; and
to the above-named person to obtain a copy of my consumer report (credit report) from any consumer reporting agency and to obtain background information about me.

Signature*

Date*

This field is hidden when viewing the form

PDF