Fillable Printable Nebraska Rental Application
Fillable Printable Nebraska Rental Application
Nebraska Rental Application
NEBRASKA RENTAL
APPLICATION
Notice: Co-Signer must complete a separate Co-Signer
Application Form
Application
Fee
$
/each
•
Security
Deposit
$
•
Monthly
Rent
$
The undersigned hereby makes application to rent
at:
beginning
on
/
/
at
a
monthly
rental
rate
of
$
PLEASE TELL US ABOUT
YOURSELF
Agent:
FULL
NAME
Hm
Ph:
Date of
Birth
/
/
Social
Security
No. -
-
Cell
Ph:
Driver's
Lic. No. & State E-mail
Address
Other Occupants: Name Name
Name
Age 19 or
over?
Age 19 or
over?
Age 19 or
over?
Relationship
Relationship
Relationship
Any
Pets?
If so, what type and how
many?
PLEASE GIVE YOUR RESIDENCE HISTORY FOR THE PAST 3 YEARS
(Beginning
With Most
Current)
Current
Address
City
State
Zip
Month & Year Moved
In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
Previous Address
City State
Zip
(If within 3
years)
Month & Year Moved
In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
Previous Address
City State
Zip
(If within 3
years)
Month & Year Moved
In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
PLEASE GIVE YOUR EMPLOYMENT
INFORMATION
YOUR STATUS:
Self Employed Employed Full-Time Employed Part-Time Student Retired Not
Employed
***If you are self
employed
, you must
provide
a copy of your most
recent
tax
return
for
proof
of
income.
CURRENT EMPLOYER (or Most
Recent)
Address
Phone
(
)
Date(s) Employed / From to Fax (
)
Supervisor
Gross
Monthly
Salary
Position
PREVIOUS
EMPLOYER
Address
Phone
(
)
Date(s)
Employed
/
From
to
Position
If there are other sources of income you would like us to consider, please list income, source and person (Banker, Employer, etc.) who we could
call
for confirmation. You do NOT have to reveal alimony, child support or spouse's annual income unless you want us to consider it in this
application.
Amount
$
Per
Source
Telephone
HAVE YOU
EVER:
Been evicted or asked to move
out?
Yes
No
Been sued for non-payment of rent?
Yes
No
Broken a rental agreement or lease?
Yes
No
Been sued for damage to rental property?
Yes No Declared
bankruptcy?
Yes
No
Been convicted of a
felony?
Yes
No
If
so
please
explain
CONTINUED
OVER
APPLICANT
NAME
MISCELANEOUS
INFORMATION
TOTAL
NUMBER
OF
VEHICLES
(Including
Company
Vehicles)
Make/Model
Year
Color
TagNo./State
Make/Model
Year
Color
TagNo./State
IN CASE OF
PERS
Full
Address:
Home
Phone:
ONAL EMERGENCY, NOTIFY:
Relationship:
Cell Phone Work
Phone
NOTE: Applicant understands that by signing this application, applicant authorizes Management to remove this rental
unit
from the rental market. Applicant is legally obligated for the rental unit, and will be held responsible accordingly. IF
I
SHOULD CANCEL THE
APPLICATION,
THE ENTIRE DEPOSIT WILL BE RETAINED AS TERMINATION
CHARGES.
APPLICANT
WILL BE
RESPONSIBLE
FOR RENT FROM DATE OF MOVE-IN OR UNTIL UNIT HAS NEW
RESIDENT
RESIDING IN IT, WHICHEVER COMES FIRST. All cancellations must be in writing. If the applicant is declined, the
deposit
may be refunded. This application must be filled out
COMPLETLEY
AND
ACCURATELY.
I understand that in the event
a
lease is entered into, it may be canceled by the landlord if any of the information provided in the application is
materially
inaccurate or incomplete. Management reserves the right to cancel this application if application is unable to have
utilities
placed in their
name.
By signing this application, I authorize the Landlord or Landlords’ agents to verify above information such as
employment,
monthly income, and past residential history. Verification or re-verification of any information contained in the application
will
be
retained by the landlord. Any person or entity identified on this application or holder of public record is hereby instructed
to
release information regarding the application, my credit, tenant, check writing histories and or my criminal record to
MANAGEMENT
. Agencies used by MANAGEMENT to acquire
this
information may include, but are not limited to, Experian
(TRW) Credit Services, Equifax/Capital CSC Credit
Services,
TeleCheck, and/or any law enforcement agency. Upon request,
HIP/ Holroyd Investment Properties will provide the name
and
phone number of any outside agency used in the verification
process.
When a Co-Signer is required, the Co-Signer Application must be filled out completely, signed and delivered to our
office
within 48 hours of being informed. If the Co-Signer Application is not received within a 48 hour period, the subject unit
applied
for may be put back on the
market.
Resident acknowledges and consents that he/she understands that MANAGEMENT is
the
Common Law agent for the owner, and
as such resident is a customer, not a client of HIP/ Holroyd Investment Properties
Inc.
Signature
of
Applicant
Date
Signed
/
/
Signature of Employee Date Signed /
/
APPLICANT:
PLEASE
DO NOT WRITE
BELOW
Application
Fee
Received:
$
Pd.
W/Ck.
#
on
/
/
Security
Deposit
Received:
$
Pd.
W/Ck.
#
on
/
/
Reference Verification Name
Reference
Comments
Landlord:
Employer:
Credit
Report:
Point
Score:
Comments:
THIS
APPLICATION
APPROVED
NOT
APPROVED
BY Title
Date
If
not
approved,
specify
reason(s)
Applicant Notified by (Name) Date
Notified
Notified by:
LETTER (Attach Copy)
FORM
TELEPONE
FAX
IN
PERSON
