Fillable Printable Vermont Rental Application Form
Fillable Printable Vermont Rental Application Form
Vermont Rental Application Form
APPLICATION TO RENT
PLEASE PRINT ALL INFORMATION
INCOMPLETE APPLICATIONS WILL BE REJECTED!
INTENDED RENTAL PROPERTY INFORMATION:
Property Address: _________________________________________________________________________________
Advertised Monthly Rent: ________________________
PERSONAL INFORMATION
:
First Name: ___________________ Middle Name: ___________________ Last Name: ______________________
Current Address:_______________________________________________________________ How Long? __________
Current Phone Number:______________________________ E-mail address: ________________________________
Previous Address:______________________________________________________________ How Long? __________
Identification - Driver’s License/Passport No.: _____________________ Other: __________________________
DOB: ________________ SS#: ____________________________ Legal Gender: M ___ F ___
How many minors will also reside with you: __________ Ages of each: ________________________________
Special Applicant Type: Student Retired Has a Job Offer Letter
Please provide the following for each location you have resided over the previous three (3) years:
Landlord’s Name
Landlord’s
phone #
Address of the Unit
Dates of
Residence
Reason for Leaving
Does Current Landlord know you are leaving the apartment/house? Yes No
VEHICLE INFORMATION:
Vehicle #1
Vehicle #2
Type of Vehicle
Make
Model
Year
Color
VIN
License Plate
State Registered In
Employment or Source of Funds Financial Information
Name of Employer/
Source of Funds
Checking Account #
Phone Number
Bank Name & City
Supervisor
Savings Account #
Position
Bank Name & City
Employed Since
Credit Cards? Yes
No
Gross Monthly
Salary/Funds
Type of Credit
Card(s)?
Mastercard Visa
Discover
AmEx
Other Sources of
Funds & Amount
Have you had a
Bankruptcy?
Yes No
PERSONAL REFERENCES:
Name: _________________________________ Address: ____________________________________________
Telephone #: (______)_____________________ Relationship to Applicant: ______________________________
Name: _________________________________ Address: ____________________________________________
Tel
ephone #: (______)_____________________ Relationship to Applicant: ______________________________
MISCELLANEOUS:
Question
Yes
No
Explanation
• Do you own any real estate?
Where?
• Do you have any pets?
• Have you ever been arrested or
charged with a crime?
• Have you ever received an
Eviction Notice from a landlord?
• Have you ever been evicted by a
landlord?
• Do you smoke?
EMERGENCY CONTACTS:
In case of emergency notify: Name: _______________________________________ Telephone #:______________
Address: ___________________________________ Relationship: ______________
SIGNATURES AND RELEASE OF INFORMATION
Please read the following prior to signing this Rental Application.
I warrant that the information supplied is true and correct, and that I am at least 18 years of age.
I am aware that the background reports I consent to may include information obtained from a variety of sources,
including but not limited to government agencies, national credit reporting agencies, and other sources. I am aware that if
I choose, I may obtain a complete disclosure of the nature and scope of any report prepared about me if I make a written
request within a reasonable time after I execute this authorization.
I also authorize and request every person, firm, company, corporation, governmental agency, court, law
enforcement office, and any other entity having control or possession of any information pertaining to me or my
background.
By this authorization, I hereby forever release, discharge, exonerate, hold harmless and indemnify Lessor,
and their affiliates, employees, representatives, agents, and subcontractors, and any other person, entity,
organization or institution furnishing information to them, from any and all liabilities of every nature and kind, including but
not limited to claims for libel, slander invasion of privacy, related tort claims, misuse of the information obtained, and any
other claim or cause of action arising out of the furnishing, inspection or copying of any documents, files, records, and
other information, or the investigation made by or on behalf of Lessor or Attacca Realty, unless such release is
determined to violate the public policy of the state or federal district in which this contract is executed, and in that event
this release will be permitted to the maximum extent allowed by the governing law. I understand that a photocopy,
facsimile or scanned copy of this signed document shall be considered as valid as an original.
I have been informed that my credit will be used to evaluate my qualifications as a potential tenant. Any
information derived from credit reports or other sources will be kept confidential and not revealed to any outside party.
I hereby acknowledge that false information given in this Rental Application may constitute grounds for rejection
of this application and/or termination of my lease.
I hereby acknowledge that incomplete Rental Applications will be rejected.
I authorize listed references, including employers and financial institutions, to release information to
Lessor (Landlord) and BBBBBBBBBBBBBBBBBBBBBBBBBBBB.
I, the undersigned Applicant(s), have read and agree to all provisions of this Rental Application.
Signature: __________________________________________
Printed Name: ____________________________________ Date: ________________________
