Charleston, Illinois

Rental Application

If accepted, this application will become part of the lease.

Unmarried co-applicants must submit separate applications; married applicants may use one application.

Property Requested

Address

Desired Move-In Date

Personal Info

Primary Applicant

Name

First Name

Last Name

Birthday

Date of Birth Month

Date of Birth Day

Date of Birth Year

Spouse

Name

First Name

Last Name

Birthday

Spouse Date of Birth Month

Spouse Date of Birth Day

Spouse Date of Birth Year

Contact Info

Primary Applicant

Phone

Email

Spouse

Phone

Email (Highly Recommended)

Occupancy

How many of each will live in this unit?

Number of Adults

Number of Children (under 18)

Number of Pets

If any of the pets are dogs

Dog Breed(s)

Weight of Dog(s)

Residence History

Current Residence

Housing Type

Address

Street Address City

State

Zip Code

How long have you been at this address?

Landlord/Mortgage Co.

Phone

Monthly Rent/Mortgage Payment

Previous Residence

Address

Street Address City

State

Zip Code

How long were at this address?

Landlord/Mortgage Co.

Phone

Monthly Rent/Mortgage Payment

Employment Info

Primary Applicant

Employer

Address

Street Address City

State

Zip Code

How long have you been employed here?

Position

Supervisor

Contact Name Contact Phone

Average Monthly Income

Spouse

Employer

Address

Street Address City

State

Zip Code

How long has he/she been employed here?

Position

Supervisor

Contact Name Contact Phone

Average Monthly Income

Professional References

You may list past employer, clergy person, school faculty, banker, etc.

Do NOT list relatives or friends.

Reference 1

Name

How many years have you known this person?

Phone

Reference 2

Name

How many years have you known this person?

Phone

Reference 3

Name

How many years have you known this person?

Phone

Vehicle

Make

Model

Year

Body Style

Color

License Plate #

License Plate State

Emergency Contact

This person must not plan to reside with you.

Name

Address

Street Address City

State

Zip Code

Phone

Relationship

Criminal Record

Do you have a criminal record (other than traffic)?

If yes

When was your most recent offense?

Where?

City

State

Zip Code

Please explain the charges.

Miscellaneous Info

How do you normally pay rent?

Name of Bank

Bankruptcy

Have you ever filed for bankruptcy?

If yes, when?

Evictions

Have you ever been served an eviction notice or asked to vacate a property you were renting?

Refused Rent Payment

Have you ever willfully or intentionally refused to pay rent when due?

If yes, when and why?

All rentals are made without regard to race, color, religion, sex, age, ancestry, marital or familial status, physical or mental handicap or national origin.

I/We authorize verification of above information from landlords, employers, credit and personal references I/we have listed and authorize the release of such by signature on this application. I/We acknowledge that false information contained herein will constitute grounds for termination of any lease arising from this application.

Under penalty of perjury, I affirm that the information provided is correct to my knowledge and hereby offer my legally-binding digital signature.

required