Rental Application - Countryside Estates

Before you submit

All adult applicants (18 years or older) must complete a separate rental application.

Please bring or provide

Driver’s license or state-issued ID Valid social security number 3 months of pay stubs (one should show previous-year detail) or SSI award letters Section 8 / Housing Choice Voucher (HCV), if applicable $35 application fee (Cash or Money Order)

Applicant Details

First Name

Middle Name

Last Name

Suffix

Social Security Number

Date of Birth

Driver's License Number

State

Cell Number

Co-Applicant

If applicable, the co-applicant must also complete and attach a separate application.

First Name

Middle Name

Last Name

Suffix

Additional Occupants

List all other residents who will be occupying the home.

Occupant 1 Name

Relationship

Date of Birth

SSN

Occupant 2 Name

Relationship

Date of Birth

SSN

Occupant 3 Name

Relationship

Date of Birth

SSN

Occupant 4 Name

Relationship

Date of Birth

SSN

Occupant 5 Name

Relationship

Date of Birth

SSN

References, Vehicles, and Pets

Personal References

Reference 1 Full Name

Phone

Reference 2 Full Name

Phone

Vehicle Information

Make

Model

Year

Color

Plate #

Make

Model

Year

Color

Plate #

Make

Model

Year

Color

Plate #

Make

Model

Year

Color

Plate #

Pets

Original form notes: maximum of 2 approved pets; pets may be permitted at management discretion; max weight 20 pounds; restricted breeds may not be allowed; registration, vaccinations, leash use, waste removal, and behavior rules apply; pet ownership includes a non-refundable $250 deposit and a $20 monthly fee.

Pet 1 Type (Cat, Dog, etc.)

Breed

Pet 2 Type (Cat, Dog, etc.)

Breed

Emergency Contact and Address History

Emergency Contact

Primary Person to Notify

Relationship

Phone

Secondary Person to Notify

Relationship

Phone

Current Address

Address

From

Landlord Name

Monthly Payment

Landlord Phone

Landlord Email

Previous Address

Address

From

Landlord Name

Monthly Payment

Landlord Phone

Landlord Email

Employment and Income

Current Employer

Address

Position

From

Supervisor

Phone

Monthly Gross Income

Previous Employer

Address

Position

From

Supervisor

Phone

Monthly Gross Income

Other Income

Other Income Source

Amount

Additional Information

Have you ever filed for bankruptcy?

Yes No

If yes, provide details

Have you ever been evicted?

Yes No

If yes, please explain

Has any occupant ever been convicted of a felony?

Yes No

If yes, please provide details

Acknowledgment

I understand that the landlord is not bound by any representation, agreement, or promise unless it is contained within a rental agreement signed by both tenant and landlord after an offer of tenancy has been extended.

I consent to allow the landlord to obtain credit information, criminal history, and related information for the purpose of determining whether to enter into a lease agreement.

Applicant Name

Date