Utah Rental Application Form

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Utah Rental Application

This form should be filled in by a potential tenant for the landlord to see his or her financial status.

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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. 190th 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.

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