Renters Screening
Application for Occupancy
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Please PRINT this application, and fill out completely. Failure to complete this application in full including daytime phone numbers, will seriously delay completion of this application
TO BE COMPLETED BY LANDLORD ONLY
Customer Name    Daytime Contact #
               Fax #
PLEASE CHECK ONE OF THE FOLLOWING SERVICED TO BE COMPLETED
Full w/o police  Credit Only Police only Full w/Police Credit/Police Only
 
RENTERS SCREENING PHONE
816-229-7500
RENTERS SCREENING FAX
816-229-3220
Desired Date of Occupancy:
Today's Date
*Name:(First, Middle, Last)           SS#
Date of Birth
Check One: Married   Single
                 Divorced Separated
Spouse Name:(First, Middle, Last) SS#
                 Spouse Date of Birth Maiden Name (if less than 2 years)
   
 
Number of people who will Occupy: Adults (over age 18) Number of children (Thru age 18)
Child's Name SS#   Child's Birth Date  
Child's Name SS# Child's Birth Date  
     
In case of emergency, notify: Name       
  Address
  Phone  
Part I- RESIDENCE HISTORY
A. Present
Address City, State, Zip
Phone: Rent $       From To
Present Landlord     Phone
B. Previous
 
Address City, State, Zip
Phone: Rent $       From To
Previous Landlord   Phone
C. Previous
Address City, State, Zip
Phone: Rent $       From To
Previous Landlord   Phone
Part II - EMPLOYMENT
A.   Employed by  Phone to verify
             Address: Position or Dept
                 From To           Income $
B.. Employed by   Phone to verify
            Address: Position or Dept
                From To           Income $
C. Other Income
   
APARTMENT INFORMATION (Must be completed by owner)
Address, Apt#, City, State, Zip of Apt Rented
 Occupants    Adults   Pets
     Children Ages   Student Y No
Length of
Lease Months 		Notice Required Days
 Apt Size
1 bdm 2 bdm
3 bdm  Studio
 Check Dep.
Cash Dep		 Move in Date
 MO Rent
 Rent include
Heat  
Elect
 
Number of Cars (include CO. Cars Driver's Lic NO   State
Make   Color   Year   License
Make   Color   Year   License
       

A processing charge of $ will be retained by the Landlord, Non-Refundable
This application must be signed by all adults who will occupy the apartment before it can be considered by Landlord. Acceptance of the application and any monies deposited herewith is not binding upon Landlord until approved by Landlord in writing. If approved, all monies deposited with this application will be held as a reservation deposit to be either returned to applicant or credited toward any deposit which may be required of applicant at the time of rental agreement is executed. If the apartment is held for applicant for more than days, all monies deposited shall be forfeited to Landlord as liquidated damaged

By signing, the applicant recognizes that an investigative report may be prepared whereby information is obtained through interview. This inquiry includes information as to your character, general reputation, employment,credit, and mode of living. Renters Screening Service (RSS) has my authorization to research all public record for criminal history for the past 7 years. I further authorize RSS to use a photocopy of my signature when necessary to verify reference; I request that such a photocopy be fully honored. The application may be disapproved as a result in any misrepresentation of insufficient information as a result of an incomplete application. You have the right to make a written request in a reasonable period of time to receive additional information about the nature and scope of this investigation.
 
Reservation Deposit with application $ 
Reservation Deposit for pets (if allowed) $ 
Total Deposit with application $ 
Signature, Applicant

Signature, Spouse