Rental Application

When do you need to move in?

How long do you anticipate staying?

Unit - First Choice  _______________________  Second Choice _______________________

Full Names

Current Address

Phone Number (& in whose name?)

Social Security number _____________________  Date of Birth _________________________

Names of all other occupants

Current residence…

& Prior Residence (past 3 years)    Name, address & phone no. of landlord with following format

Address      from ___to____ Reason for leaving;  

Owner or agent_____phone (  )__ ____ Rent paid/month

Address      from ___to____ Reason for leaving;  

Owner or agent_____phone (  )__ ____ Rent paid/month

Address      from ___to____ Reason for leaving;  

Owner or agent_____phone (  )__ ____ Rent paid/month

Other occupant references for short term renting?

Credit References 

1. Electric co.   Name and Phone number  Address of dwelling you were responsible for:

2. Fuel co.         Name & phone number

3. Other

Personal References:

Please give name, how they know you, their phone number

1.

2.

3.

Prior Employer, supervisor, phone  (How long employed? From___ to ___)

Current Employer & Supervisor, phone (How long employed?)

Will you be continuing in the same job?  _____ Or is this a job transfer? ______ or a New Job? __________

Valdez Employer, if different ___________________  Contact _____________________________________

What are your sources of income for paying rent?

How much do you earn each month? _____________________ 

What are your fixed monthly debt payments/month? ________   Total amount owed? ___________

Please answer the following questions:

Car type, age  & number that will be parked?

Any pets?   How many?   Kind of Pet, Breed, Weight and Age?

Are you or anyone else who would be living in the rental a smoker?      

 ..If a smoker, heavy or light smoker?

Have you ever been sued for non-payment of rent?

Have you ever been evicted or asked to move out?

Have you ever broken a rental agreement or lease?

Have you ever been sued for damage to rental property?

Have you ever moved from a rental unit without cleaning it?

Have you ever initiated a lawsuit?        If so, explain

Narrative (optional, but could be helpful to you)

Please introduce yourself & what you’re looking for in housing in Valdez

I authorize_______, owner or co-owner of rental units & to contact previous landlord(s), Credit and personal references that I have given in this application.  

I also authorize management to obtain my consumer credit report or to be notified by utility company of any credit history affecting their decision for credit

In lieu of deposit, I authorize my credit card number to be used upon move-in if any rent owning or cleaning, etc. is required for tenancy. 

The above information, to the best of my knowledge, is true and correct.  This application shall be included as part of the rental lease agreement.

Signature of Applicant                               Date signed

Signature of Co-Applicant                         Date signed

In case of Emergency, who to contact:

Electric co application copy to be a part of this application also,

Residential Application  Sometimes deposit can be waived otherwise $100- $150

Please mail completed application, the application is considered signed per receipt of mailing.

 (Followed by a signed hard copy faxed or mailed: Hursh Realtors, PO Box 233, Valdez, AK 99686)

Holding deposit of $50 non refundable to process application, to be applied towards rent upon approval, or returned if non approved or forfeited if rental is approved & not taken

Should you wish a lease beyond ________ a prepaid last month’s rent is required, to be forfeited towards higher rent during term so taken, if full lease is not honored.

Note:  All above information is kept in confidence by owner/agent.