611 5th Street, apt # 5, Mosinee, WI 54455

APPLICANT INFORMATION

Name *

First

Last

SSN *

Phone Number *

Date of Birth

Pet Information

Email Address *

Other Occupant Information (includes minors)

1st Occupant

Name *

SSN

Age

Relationship

2nd Occupant

Name *

SSN

Age

Relationship

3rd Occupant

Name *

SSN

Age

Relationship

4th Occupant

Name *

SSN

Age

Relationship

HOUSING REFERENCES

Current Address

Address Line 1

City

State

Zip Code

From *

To *

Rent/Mortgage Paid

Landlord/Mortgage Holder

Their Phone #

Reason for leaving

Previous Address

Address Line 1

City

State

Zip Code

From *

To *

Rent/Mortgage Paid

Landlord/Mortgage Holder

Their Phone #

Reason for leaving

VEHICLE INFORMATION

Numbers of Vehicles

Driver’s License #

State

Vehicle Make/Model

Color

Year

Plate

Vehicle Make/Model

Year

Color

Plate

EMPLOYMENT REFERENCES

Present (Local) Employer

Phone

Address

Address Line 1

City

State

Zip Code

Wage

Start Date

Position

How long do you plan to stay

2nd Employer/Additional Income

Phone

Address

Address Line 1

City

State

Zip Code

Wage

Start Date

Position

How long do you plan to stay

EXPECTED HOUSEHOLD MONTHLY INCOME

Wages (Employer)

$

Wages (Employer)

$

Public Assistance (Source)

$

Parents

$

Support Payments (Source)

$

Other Sources of Income

$

FINANCIAL INSTITUTIONS

Checking Account

Bank

City

Savings Account

Bank

City

OTHER GENERAL INFORMATION

Have you ever been evicted or served an eviction notice?

Yes
No

Have you ever failed to pay rent when due?

Yes
No

Have you ever filed for bankruptcy or consulted a bankruptcy attorney?

Yes
No

Have you every been arrested or convicted for other than a traffic offense?

Yes
No

Explain any “YES” answers above

Do you have the right to legally enter a lease or other contract?

Yes
No

EMERGENCY CONTACT INFORMATION

Contact #1

Name *

Phone

Work Phone

Address

Address Line 1

City

State

Contact #2

Name *

Phone

Work Phone

Address

Address Line 1

City

State

Contact #3

Name *

Phone

Work Phone

Address

Address Line 1

City

State

APPLICANT ACKNOWLEDGEMENT

Please Read Carefully and Sign This Application This application is NOT a rental agreement, contract, or lease! All applications are subject to approval. NOTICE: You may obtain information about the sex offender registry and persons registered with the registry by contract the Wisconsin Department of Corrections on the Internet at https://appsdoc.wi.gov/public/offenders or by phone at 877-234-0085 (make click to call). By signing below, I warrant and represent that I am at least 18 years of age and that all statements herein are true and correct, to the best of my knowledge. Also, I hereby consent to routine and periodic inquiry of references and credit agencies to provide applicable information concerning applicants character, address, creditworthiness, reliability, and income amount and hereby authorizes the release of this information to Emmerich & Associates, Inc. / Emmerich Properties.

Signature

Date

OPTIONAL: Earnest Money Disclosure (ONLY if Earnest Money is Paid)

Receipt of earnest money deposit in the sum of $ TEXT BOX is hereby acknowledged; deports to be returned if application is not approved or no action is taken with TEXT BOX calendar days (if left blank, three days are assumed). If approved, this sum to be applied to security depost and/or first month’s rent. If applicant decides not to enter into a rental agreement after application approval, actual costs and damages incurred will be deducted from the deposit. Depost may be withheld as compensation for lost rent if landlord make reasonable efforts to mitigate damages in accordance with 704.29 Wisconsin Statutes. By signing below, i am certifying that i was given the opportunity to review a sample lease or rental agreement, and acknowledge that Earnest Money will be treated in accordance with WI SS 704.27 and ATCP 134.

Signature

Date

611 5^th Street, Apt #5, Mosinee, WI 54455

RENTAL APPLICATION

APPLICANT INFORMATION

Other Occupant Information (includes minors)

1st Occupant

2nd Occupant

3rd Occupant

4th Occupant

HOUSING REFERENCES

VEHICLE INFORMATION

EMPLOYMENT REFERENCES

EXPECTED HOUSEHOLD MONTHLY INCOME

Parents

FINANCIAL INSTITUTIONS

Checking Account

Savings Account

OTHER GENERAL INFORMATION

EMERGENCY CONTACT INFORMATION

APPLICANT ACKNOWLEDGEMENT

OPTIONAL: Earnest Money Disclosure (ONLY if Earnest Money is Paid)

611 5th Street, Apt #5, Mosinee, WI 54455

RENTAL APPLICATION

APPLICANT INFORMATION

Other Occupant Information (includes minors)

1st Occupant

2nd Occupant

3rd Occupant

4th Occupant

HOUSING REFERENCES

VEHICLE INFORMATION

EMPLOYMENT REFERENCES

EXPECTED HOUSEHOLD MONTHLY INCOME

Parents

FINANCIAL INSTITUTIONS

Checking Account

Savings Account

OTHER GENERAL INFORMATION

EMERGENCY CONTACT INFORMATION

APPLICANT ACKNOWLEDGEMENT

OPTIONAL: Earnest Money Disclosure (ONLY if Earnest Money is Paid)

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611 5^th Street, Apt #5, Mosinee, WI 54455