Vermont Rental Application Form

Through the information reflected in this form, the landlord will be able to review a prospective tenant’s credit history and relevant background. As such, the landlord will be able to decide whether to approve or reject the lease application.Download

Extracted Text for Proper Search

APPLICATION TO RENT  	
POTENTIAL LANDLORD’S INFORMATION	: 
 	
Name of Landlord: ______________________________________  Landlord’s Phone Number: ____________________ 
 
Landlord’s Address: _______________________________________________________ (send application here). 
 
Apartment Address: _______________________________________________________________________________ 
 
Monthly rent: $________________*  Security deposit: $__________________*  Available date: ____________ 
* 
First month’s rent and security deposit are to be paid by cashier’s check or cash. 
 	
PLEASE PRINT ALL INFORMATION	 
INCOMPLETE APPLICATIONS WILL BE REJECTED! 	
 
PERSONAL INFORMATION	: 	
 
Name: ____________________________________________  DOB: _____________  SS#: _____________________ 
 
Current Address:_________________________________________________________________________ 
 
Current Phone Number:______________________________    E-mail address: _______________________________ 
 
Identification - Driver’s License/Passport No.: _____________________  Other: ___________________ 
 
Please provide the following for each location you have resided over the previous three (3) years: 
 
Landlord’s Name Landlord’s 
phone # Address of the Unit Dates of 
Residence Reason for Leaving 
 
 
       
 
 
       
 
 
       
 
Does Current Landlord know you are leaving the apartment/house?       Yes           No 
 
VEHICLE INFORMATION	: 
 	
 	Vehicle #1  Vehicle #2 	
Type of Vehicle 	  	
Make 	  	
Model 	  	
Year 	  	
Color 	  	
VIN 	  	
License Plate 	  	
State Registered In

Employment or Source of Funds  Financial Information 	
Name of Employer/ 
Source of Funds  Checking Account #  
 	
Phone Number 
  Bank Name & City 
 	
Supervisor 
  Savings Account # 
 
Position 
  Bank Name & City 
 	
Employed Since 
  Credit Cards? 
       Yes           No 
Gross Monthly 
Salary/Funds  Type of Credit 
Card(s)?     Mastercard         Visa 
     AmEx          Discover 
Other Sources of 
Funds & Amount   
 	
 
PERSONAL REFERENCES	:  	
 
Name: _________________________________  Address: ____________________________________________ 
Telephone #: (______)_____________________  Relationship to Applicant: ______________________________ 
 
Name: _________________________________  Address: ____________________________________________ 
Telephone #: (______)_____________________  Relationship to Applicant: ______________________________ 
 
 
Name: _________________________________  Address: ____________________________________________ 
Telephone #: (______)_____________________  Relationship to Applicant: ______________________________ 
 
MISCELLANEOUS	
: 	
 
Question Yes No  Explanation  
•  Do you own any real estate? 
   Where? 
•  Do you have any pets?     If yes, please fill out and submit the Pet Resume 
 
•  Have you ever been arrested or 
charged with a crime? 
    
•  Have you ever received an 
Eviction Notice from a landlord?  
    
•  Have you ever been evicted by a 
landlord? 
    
•  Do you smoke? 
    
 
EMERGENCY CONTACTS	: 	
 
In case of emergency notify:  Name: _______________________________________ Telephone #:______________ 
     
Address: ___________________________________  Relationship: ______________

SIGNATURES AND RELEASE OF INFORMATION	 
 	
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 hereby authorize ________________________________ (“Lessor”) and its designee, ScreeningOne, Inc., 2233 
W. 190	
th Street, Torrance, CA  90504, (866) 273-3848, and its designated agents and representatives (individually and 
together (“ScreeningOne”), to conduct a comprehensive background check that includes any one or all of the following:  
Consumer and/or business credit report, past employment and tenancy, criminal, drug, and driving records.  I understand 
that one or more of the above-referenced checks may require additional written authorizations and consents, and I hereby 
agree to provide all such further written authorizations and consents. 
 
I am aware that the background reports I consent to have prepared may include information obtained from a 
variety of sources, including but not limited to government agencies, national credit reporting agencies, and other sources.  
I am aware that if I choose, I may obtain a complete disclosure of the nature and scope of any report prepared about me if 
I make a written request to ScreeningOne, within a reasonable time after I execute this authorization. 
 
I also authorize and request every person, firm, company, corporation, governmental agency, court, law 
enforcement office, and any other entity having control or possession of any information pertaining to me or my 
background to furnish same to ScreeningOne.   
 
By this authorization, I hereby forever release, discharge, exonerate, hold harmless and indemnify Lessor,  
ScreeningOne, and their affiliates, employees, representatives, agents, and subcontractors, and any other person, entity, 
organization or institution furnishing information to them, from any and all liabilities of every nature and kind, including but 
not limited to claims for libel, slander invasion of privacy, related tort claims, misuse of the information obtained, and any 
other claim or cause of action arising out of the furnishing, inspection or copying of any documents, files, records, and 
other information, or the investigation made by or on behalf of Lessor or ScreeningOne, unless such release is 
determined to violate the public policy of the state or federal district in which this contract is executed, and in that event 
this release will be permitted to the maximum extent allowed by the governing law.  I understand that a photocopy, 
facsimile or scanned copy of this signed document shall be considered as valid as an original. 
 
    I have been informed that my credit will be used to evaluate my qualifications as a potential tenant.  Any 
information derived from credit reports or other sources will be kept confidential and not revealed to any outside party. 
 
  I hereby acknowledge that false information given in this Rental Application may constitute grounds for rejection 
of this application and termination of your lease. 
 
  I hereby acknowledge that incomplete Rental Applications will be rejected. 
 
 I authorize listed references, including employers and financial institutions, to release information to 
Lessor (Landlord). 
 
  I, the undersigned Applicant(s), have read and agree to all provisions of this Rental Application. 
 
 
 
Signature: __________________________________________   
 
Printed Name: ____________________________________  Date: ________________________ 
 
Current Address: _______________________________________________________________________ 
 	
 	
PLEASE RETURN TO THE LANDLORD 
 	
Form Created by:  VERMONT APARTMENT OWNERS ASSOCIATION, LLC 
PO Box 701, Shelburne, Vermont  05482-0701 
www.vaoa.com	
 • 1-888-LOW RENT  	
© Vermont Apartment Owners Association, LLC 2007. All rights reserved.