Vermont Apartment Owners Association >> VT Landlord Tenant, Laywers, Attorney, Legal Fees, Organization

APPLICATION TO RENT
PLEASE FILL OUT ALL INFORMATION
To: fredoes@adelphia.net	Apartment Info: Derby Apartments Derby:Rte 5
APPLICANT PERSONAL INFORMATION:
(REQUIRED) Your Name:	EX: 01/01/2003 Date Of Birth:
EX: xxx-xx-xxxx Social Security Number:	Applicant's Current Address:
Current RA/Landlord's Name:	EX: 1-802-555-1212 RA/Landlord's Phone Number:
Current RA/Landlord's Address:	Applicant's Reason For Leaving Current Address:
Does Current RA/Landlord know you are leaving the apartment/house? Yes No	(REQUIRED) Your Email Address:
(REQUIRED) Your Phone Number:	Your Cell Phone Number:

Prior RA/Landlord's Name:	EX: 1-802-555-1212 RA/Landlord's Phone Number:
Prior RA/Landlord's Address:	Applicant's Reason For Leaving Prior Address:
APPLICANT EMPLOYMENT/INCOME:
Applicant's Current Employer/ Source of Income:	Employer's Phone Number:
Business Address:	Position:
Supervisor:	Employed Since:
Gross Monthly Salary/Income $	Frequency of Wages/Income:
PERSONAL REFERENCES:
Name	Address
Telephone	Relationship to Applicant:

Name	Address
Telephone	Relationship to Applicant:

Name	Address
Telephone	Relationship to Applicant:
PETS/ANIMALS: Please list all animals that you would like to have in the unit you rent
Type:	Age:
Name:	Vet's name:
Declawed: Yes No	Spayed/Neutered: Yes No
License No.:	Remarks:

Type:	Age:
Name:	Vet's name:
Declawed: Yes No	Spayed/Neutered: Yes No
License No.:	Remarks:
MISCELLANEOUS:
Have you ever been charged with or convicted of a crime ?	Yes No
If yes, please provide details:
IDENTIFICATION:
Drivers License Number:	Passport:
Other:
EMERGENCY: In case of emergency notify:
Name:	Telephone:
Address:	Relationship:

Name:	Telephone:
Address:	Relationship:
SIGNATURES: Please read the following prior to signing this Rental Application.
I warrant that the information supplied is true and correct, and that I am at least 18 years of age. I have been informed that the owner is a member of the Credit Bureau Services of Vermont, and may check my credit with CBSV to evaluate my qualifications as a potential tenant; to evaluate my qualifications if the lease is to be renewed; and for rent collection purposes if required. Owners is allowed by contract with CBVS to report any rent delinquency, eviction, or for rent collection purposes. Owner further warrants that any information derived from credit reports or other sources will be kept confidential and not revealed to any third party. I hereby acknowledge that false or incomplete information given in this Rental Application shall constitute grounds for rejection of this application, termination of any tenancy or occupancy created in whole or in part on false or incomplete information contained in this application, and may constitute criminal offense under the laws of this state. I, the undersigned Applicant(s), have read and agree to all provisions of this Rental Application.
Signature:	Date:
Print This Page Before Submitting. You may need to provide a written signature to the landlord in addition to this document.

VERMONT APARTMENT OWNERS ASSOCIATION, LLC PO Box 701 Shelburne, Vermont 05482-0701 vermontapartmentowners.org 1-888-LOW RENT © Vermont Apartment Owners Association, LLC 2003, All rights reserved.

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