Credit Application
Credit Application for Rental
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*Name:
Driver's License Number:
Social Security Number:
*Home Phone Number:
Work Phone Number
*Email address:
Married:
Yes
No
Number of Children:
Ages
Boy
Girl
Ages
Boy
Girl
Ages
Boy
Girl
Do you have Pets?
Yes
No Type:
Are you a smoker?
Yes
No
Other Occupants:
Name:
Relationship
Driver's License Number:
Name:
Relationship
Driver's License Number:
Name:
Relationship
Driver's License Number:
Employment
Present Employer
How Long
Address:
Phone Number:
Title:
Salary
per
Spouse Present Employer
How Long
Address:
Phone Number:
Title:
Salary
per
Other Income:
$
per
Rental History for the Last Three Years
Present Address:
City:
How Long:
Reason for Leaving
Name of Manager
or Owner:
Phone Number:
Address:
City:
How Long:
Reason for Leaving
Name of Manager
or Owner:
Phone Number:
Address:
City:
How Long:
Reason for Leaving
Name of Manager
or Owner:
Phone Number:
Name of Closest
Relative:
Relationship
Phone number
Have you ever filed for bankruptcy?
Yes
No
Have you ever been evicted form any tenancy?
Yes
No
Have you ever willfully and intentionally refused to pay any rent when due?
Yes
No
J. R. Rush Properties, L.L.C. has my persmission to acquire or verify the information above and agrres to pay a $40.00 application fee.
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