1001 Pine Street apt #5

For Rent

Rent $555

Security Deposit: $555

RENTAL APPLICATION

APPLICANT INFORMATION

Name *

First

Last

SSN *

Phone Number *

By providing your phone number, you agree to receive text messages from Emmerich Properties for the purpose of communicating community news, urgent notifications, and events. Reply “STOP” to opt-out anytime or reply “HELP” for more information. Message and data rates may apply. Message frequency will vary. For more information, please read our Privacy Policy and Terms of Service.

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)

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?

Have you ever failed to pay rent when due?

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

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

Explain any “YES” answers above

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

EMERGENCY CONTACT INFORMATION

Contact #1 *

First

Last

Phone

Work Phone

Address

Address Line 1

City

State

Contact #2 *

First

Last

Phone

Work Phone

Address

Address Line 1

City

State

Contact #3 *

First

Last

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

If you would prefer to print off a copy of the Application for Residency, click here to download the PDF.