Rental Application

After submitting this form, you must pay the $20 application fee to the office at 949 Batesville Blvd.

First Name*

Middle Name*

Last Name*

Street Address*

State*

Zip Code*

Birthdate*

Social Security Number*

Drivers License Number*

DL State*

Phone Number*

Email Address

How many adults would be in your home?*

How many children would be in your home?*

Have you ever been evicted?

Yes
No

If yes, please explain.

Do you have pets?

Yes
No

If yes, please explain.

Have you ever been convicted of a felony?

Yes
No

If yes, please explain.

Have you ever been sued by a landlord?

Yes
No

If yes, please explain.

Has a landlord ever withheld a deposit from you?

Yes
No

If yes, please explain.

List your last two landlords with contact information.*

What is the property address that you're interested in renting?*

What date would you like to take possession of the property?*

What date would you like to take possession of the property?

I grant, The Property Shoppe, permission to run a criminal and credit background screening.

Yes
No

Full Name*

Date*

Date

You can submit this form only once.

Sarah Perkins, Realtor®