RICHARD H. GERCKEN
137 N STEWART RD SUITE 100
LIBERTY MO 64068
PH 816-781-7491 FAX
816-781-7496
RENTAL APPLICATION
DATE
PROPERTY
ADDRESS
1. Applicant
Age
Name
2. Address Phone
3. Co-Applicant Phone
4. Names of all persons proposing to live in
dwelling unit:*
Name Age Name
Age Name Age
*At landlords request, separate rental application may be required for
each person listed above
5. Will you have pets? Describe
6. Present landlord:
Name Address
Phone
7. List you last two previous residences:
(A) Landlord
Address Apt. Name
City State Zip Address Phone
Rented From (date) to (date) Monthly
Rent
(B) Landlord
Address Apt.
Name
City
State Zip Address Phone
Rented From (date) to (date) Monthly Rent
8. Employer:
Name
Address Phone
Position: Supervisor How Long Employed
9. Other Income:
Name of source
Address Phone
Position: Income
per month
Source (circle one) :
Spouse employment, child support/alimony/maintenance, public assistance, other
(explain)
10. Combined monthly income of all applicants:
11. Identification
a. Applicant: Social Security No. Drivers License Number/State
b.
Spouse Social Security No. Drivers License
Number/State
12. Excluding current employer, list two most
recent employers:
a.
Name Address Phone
Position How long employed? Pay
Immediate supervisor
b.
Name Address Phone
Position How long employed? Pay
Immediate supervisor
13. List three credit references or credit
card accounts:
a. Name Address Acct. No. Phone
b. Name Address
Acct. No. Phone
c. Name Address
Acct. No. Phone
14. Name of Bank: Address Phone
15. List three person ( Not
related to you) who have knowledge of your character and reputation:
a. Name Address
Phone
b. Name Address
Phone
c. Name Address Phone
16. Contact in case of
emergency: . Name Address
Phone
17. Automobiles:
a. Make Year Color License State
b. Make Year Color License State
Important:
In making this
Rental Application it is understood that an investigative consumer report may
be prepared whereby information is obtained through personal interviews with
your neighbors, friends, or others with whom you are acquainted. This inquiry
includes information as to our character, general reputation, personal
characteristics and mode of living. You have the right to make a written
request within a reasonable period of time to receive additional, detailed
information about the nature and scope of this investigation.
In signing and
submitting this application, applicant(s) authorize Landlord or his agents to
contact applicants’ references, verify the facts reported by applicant, and
make inquiries into other facts related to applicant’s fitness as a tenant.
Acceptance by landlord of
this application and any money deposited herewith shall not form an agreement binding
upon Landlord until Landlord accepts this application in writing.
A
non-refundable application fee of $ 25.00 has been submitted (per application )with
this application,. Upon Landlord’s acceptance of applicant a lease describing
the terms of occupancy and duration will be provided by the landlord. Upon the
applicants acceptance of the lease the security deposit of $ shall
be due and payable. When the keys to the unit are provided to applicant the
rental fees for the beginning (or partial) months occupancy will be due.
I hereby acknowledge that I
have read the provisions of this application and that the answers submitted are
true.
Signed:
Applicant Date Co-applicant Date