Fillable Printable Nebraska Rental Application
Fillable Printable Nebraska Rental Application
Nebraska Rental Application
NEBRASKA RENTAL
APPLICATION
Notice:Co-Signermustcomplete a separateCo-Signer
ApplicationForm
Application
Fee
$
/each
•
Security
Deposit
$
•
Monthly
Rent
$
Theundersignedherebymakesapplicationtorent
at:
beginning
on
/
/
at
a
monthly
rental
rate
of
$
PLEASETELLUSABOUT
YOURSELF
Agent:
FULL
NAME
Hm
Ph:
Dateof
Birth
/
/
Social
Security
No.-
-
Cell
Ph:
Driver's
Lic.No.& StateE-mail
Address
OtherOccupants:NameName
Name
Age19or
over?
Age19or
over?
Age19or
over?
Relationship
Relationship
Relationship
Any
Pets?
Ifso,whattypeandhow
many?
PLEASEGIVEYOURRESIDENCEHISTORYFORTHEPAST3 YEARS
(Beginning
WithMost
Current)
Current
Address
City
State
Zip
Month& YearMoved
In
/
MonthlyRent:$
ResonforLeaving:
Landlord
Phone:
Fax:
PreviousAddress
CityState
Zip
(If within3
years)
Month& YearMoved
In
/
MonthlyRent:$
ResonforLeaving:
Landlord
Phone:
Fax:
PreviousAddress
CityState
Zip
(If within3
years)
Month& YearMoved
In
/
MonthlyRent:$
ResonforLeaving:
Landlord
Phone:
Fax:
PLEASEGIVEYOUREMPLOYMENT
INFORMATION
YOURSTATUS:
SelfEmployed EmployedFull-Time EmployedPart-Time Student Retired Not
Employed
***Ifyouare self
employed
, youmust
provide
a copy ofyour most
recent
tax
return
for
proof
of
income.
CURRENTEMPLOYER(orMost
Recent)
Address
Phone
(
)
Date(s)Employed/ FromtoFax(
)
Supervisor
Gross
Monthly
Salary
Position
PREVIOUS
EMPLOYER
Address
Phone
(
)
Date(s)
Employed
/
From
to
Position
Ifthere are othersources ofincome youwouldlike ustoconsider, please list income, source andperson (Banker, Employer, etc.) whowecould
call
forconfirmation. You doNOThavetoreveal alimony,child support orspouse's annualincome unless youwantustoconsider itinthis
application.
Amount
$
Per
Source
Telephone
HAVEYOU
EVER:
Beenevictedoraskedtomove
out?
Yes
No
Beensuedfornon-paymentofrent?
Yes
No
Brokena rentalagreementorlease?
Yes
No
Beensuedfordamagetorentalproperty?
Yes No Declared
bankruptcy?
Yes
No
Beenconvictedofa
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
INCASEOF
PERS
Full
Address:
Home
Phone:
ONALEMERGENCY,NOTIFY:
Relationship:
CellPhoneWork
Phone
NOTE: Applicantunderstandsthatbysigningthisapplication,applicantauthorizesManagementtoremovethisrental
unit
fromtherentalmarket.Applicantislegallyobligatedfortherentalunit,andwillbeheldresponsibleaccordingly. IF
I
SHOULDCANCELTHE
APPLICATION,
THEENTIREDEPOSITWILLBERETAINEDASTERMINATION
CHARGES.
APPLICANT
WILLBE
RESPONSIBLE
FORRENTFROMDATEOFMOVE-INORUNTILUNITHASNEW
RESIDENT
RESIDINGINIT,WHICHEVERCOMESFIRST.Allcancellationsmustbeinwriting. Iftheapplicantisdeclined,the
deposit
mayberefunded.Thisapplicationmustbefilledout
COMPLETLEY
AND
ACCURATELY.
I understandthatintheevent
a
leaseisenteredinto,itmaybecanceledbythelandlordifanyoftheinformationprovidedintheapplicationis
materially
inaccurateorincomplete. Managementreservestherighttocancelthisapplicationifapplicationisunabletohave
utilities
placedintheir
name.
Bysigningthisapplication,I authorizetheLandlordorLandlords’agentstoverifyaboveinformationsuchas
employment,
monthlyincome,andpastresidentialhistory. Verificationorre-verificationofanyinformationcontainedintheapplication
will
be
retainedbythelandlord. Anypersonorentityidentifiedonthisapplicationorholderofpublicrecordisherebyinstructed
to
releaseinformationregardingtheapplication,mycredit,tenant,checkwritinghistoriesandormycriminalrecordto
MANAGEMENT
. AgenciesusedbyMANAGEMENTtoacquire
this
informationmayinclude,butarenotlimitedto,Experian
(TRW)CreditServices,Equifax/CapitalCSCCredit
Services,
TeleCheck,and/oranylawenforcementagency.Uponrequest,
HIP/HolroydInvestmentPropertieswillprovidethename
and
phonenumberofanyoutsideagencyusedintheverification
process.
Whena Co-Signerisrequired,theCo-SignerApplicationmustbefilledoutcompletely,signedanddeliveredtoour
office
within48hoursofbeinginformed.IftheCo-SignerApplicationisnotreceivedwithina 48hourperiod,thesubjectunit
applied
formaybeputbackonthe
market.
Residentacknowledgesandconsentsthathe/sheunderstandsthatMANAGEMENTis
the
CommonLawagentfortheowner,and
assuchresidentisa customer,notaclientofHIP/HolroydInvestmentProperties
Inc.
Signature
of
Applicant
Date
Signed
/
/
SignatureofEmployeeDateSigned/
/
APPLICANT:
PLEASE
DO NOT WRITE
BELOW
Application
Fee
Received:
$
Pd.
W/Ck.
#
on
/
/
Security
Deposit
Received:
$
Pd.
W/Ck.
#
on
/
/
ReferenceVerificationName
Reference
Comments
Landlord:
Employer:
Credit
Report:
Point
Score:
Comments:
THIS
APPLICATION
APPROVED
NOT
APPROVED
BYTitle
Date
If
not
approved,
specify
reason(s)
ApplicantNotifiedby(Name)Date
Notified
Notifiedby:
LETTER(AttachCopy)
FORM
TELEPONE
FAX
IN
PERSON
