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Utah Rental Application Form

Through the information shared in this form, a Utah-based landlord will be able to assess the financial status of a prospective tenant.

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Rental Application - Page 1 of 2  RENTAL APPLICATION  Please Return to Name: Email: Phone: ( ) - Fax: ( ) - Property address applied for Date needed /_ /  1. Applicant's Info. Name   Sex_ Birth Date_ / / SS# _-_ _-_  Present Address Apt #   City   State Zip Home ( _) - Cell ( ) - Email_ Driver's License No._ State_ Marital status Single Married Other   Explain   2.  Rental History Current Landlord  Address  City  State Phone ( ) _-_ How long at this address?  Months and Years . Previous Landlord Address City State Phone ( ) _-_ How long at this address?  Months and Years .  3.  Work History Current Employer Type of Work Phone at Work (_ _) Previous Employer Type of Work Phone at Work (_ _)     _-_   _-_   Address  Monthly Income $ Address  Monthly Income $   City Worked from /  City Worked from /  until until   State /  State /  4.   Co-Applicant's Info. Name Present Address   Apt #  Sex_  Birth Date_ / City  /  SS# State  _-_ Zip  _-_ Home ( _) - Cell ( ) - Email_ Driver's License No._ State_ Marital status Single Married Other   Explain   5.  Co-Applicant’s Work History Current Employer Type of Work  Address  City Worked from /   until  State / Phone at Work (_ _) Previous Employer Type of Work Phone at Work (_ _) _-_   _-_ Monthly Income $ Address  Monthly Income $  City Worked from /   until  State /  6.  Other Income. $    per month in    Unemployment   Child Support    Alimony     Other (explain):      7.   Occupants. List name, age, and relationship of all persons, other than yourself, that will be occupying the premises (including children, relatives, and other co-residents): Name Age Relationship Name Age Relationship Name Age Relationship Name Age Relationship Name Age Relationship Name Age Relationship  8.   Vehicles.  List all vehicles to be parked on the premises by applicant, spouse, children (including cars, trucks, motorcycles, etc.): Make Model Year Color License # State Make Model Year Color License # State Make Model Year Color License # State  9.   Smoking. Will anyone occupying the residence be smoking?  _. If Yes, how many?  . Are you willing to smoke outside? . By initialing below, I agree to be responsible for any smoking damage to the dwelling caused by me, my family, invitees, or guests.  Damage shall include but not be limited to replacing any burned flooring or counter tops, repainting walls, and/or other costs, fines or charges as stated in the rental agreement between myself and the Landlord.   /   Initials  10. Pets. Will anyone have a pet?  Kind  Weight  Breed  Age By initialing below, I agree to be responsible for any pet damage in the dwelling that occurs during my occupancy. Damage shall include but not be limited to replacing all carpeting and pad in the entire unit.   /   Initials  11. Bank Name Checking Account No. Savings Account No.  City  Phone ( ) -_ Approx. Balance $ Approx. Balance $

Rental Application - Page 2 of 2  12. Current Debts (Everyone you make payments to)   Company (Creditor) Balance (Amount you owe) Monthly Payment 1.    2.    3.    4.    5.     13. Why are you leaving your current residence?      14. Have you or your spouse ever been evicted?    If Yes, explain.      15. Have you or your spouse ever broken a rental agreement or lease contract? If Yes, explain.   16. Have you or your spouse ever been sued for non-payment of rent or damages to rental property? If Yes, explain.   17. Have you or your spouse ever been convicted of a felony? If Yes, explain.   18. Have you or your spouse ever filed bankruptcy? If Yes, what month & year? Is it now discharged? When was (or when will) it be discharged?  19. How did you find us?  Just stopped by,  Newspaper,  Vacancy Sign,  Friend (name) Real Estate Agent  20. What features do you particularly like here: , or Other (please explain)   21. Emergency Contacts Option #1 Name Address Option #2 Name Address  Phone (_ Apt # Phone (_ Apt #  _)  _- City _)  _- City  Relationship State Relationship State   Zip  Zip  CORRECT INFORMATION – (You must sign to complete application)  The Applicant represents all of the above statements to be true and complete, and hereby authorizes verification to be made of above information, references, credit history and criminal background.  The  Applicant  acknowledges  that false information herein constitutes a  material breach of any rental agreement entered based on this application and authorizes the Landlord to evict or deny possession to the Applicant. False information provided on this document may also constitute a criminal offense under the laws of the state of Utah and be cause for eviction, denial of tenancy or prosecution. At the time a security deposit is paid by the Applicant to the Landlord or the  Landlord’s representative to show the Applicant's intent to secure and/or hold a specific rental property, the Applicant understands and agrees to the following:  (1) the payment and receipt of the security deposit does not guarantee the approval of any application or that the Applicant is guaranteed tenancy; (2) if the Landlord's approval is not given, the security deposit will be  refunded to the Applicant, and (3) if the application is approved by the Landlord or the Landlord's representative, any security deposit paid becomes NON-REFUNDABLE if for any reason, at the fault of the Applicant, the Applicant fails to execute the Rental Agreement.  Applicant #1 (Print)      (Sign)       Date     Applicant #2 (Print)      (Sign)        Date       Copyright © 2009.  This form provided by the Law Offices of Jeremy M. Shorts, LLC.  Rev. 1-1-09
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