Apply For A Rental Home

1) Desired Residence Street Address, City, State, Zip Code
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2) First Name
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3) Middle Name
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4) Last Name
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5) Birth Date
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6) Social Security Number
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7) Former Name(s)
8) Driver's License Number
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9) Driver's License State
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10) Current Phone Number
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11) Current Email Address
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12) Preferred Method of Contact
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13) If you have children under the age of 18, or if are you a legal representative completing an application for a disabled applicant who is unable to write legibly, please complete the fields below (up to question number 14). These applicants do not need separate applications. However, two forms of I.D. for each additional applicant must be sent to info@Collins2Collins.com. If completing an application for a disabled applicant, please note that you must send a signed statement stating that you are completing an application for a disabled applicant. The statement must include the legal representative’s full name, signature, relationship to disabled applicant, current phone number, email address, and mailing address. If you are not completing an application for a child or a disabled applicant, please answer "No" and skip to question number 14 (Current Residence Street Address).
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Additional Applicant Full Name (First, Middle, Last)
Additional Applicant Birth Date
Additional Applicant Social Security Number
Is Additional Applicant under Age 18, Disabled, or Both?
Additional Applicant Full Name (First, Middle, Last)
Additional Applicant Birth Date
Additional Applicant Social Security Number
Is Additional Applicant under Age 18, Disabled, or Both?
Additional Applicant Full Name (First, Middle, Last)
Additional Applicant Birth Date
Additional Applicant Social Security Number
Is Additional Applicant under Age 18, Disabled, or Both?
14) Current Residence Street Address, City, State, Zip Code
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15) Current Owner / Manager Name
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16) Current Owner / Manager Phone Number
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17) Reason for Leaving Current Residence
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18) Did You Give Notice for Leaving?
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19) Last Rent Amount Paid for Current Residence
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20) Move In Date for Current Residence
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21) Previous Residence Street Address, City, State, Zip Code
22) Previous Owner / Manager Name
23) Previous Owner / Manager Phone Number
24) Previous Rent Amount Paid
25) Length of Time at Residence (MM/DD/YYYY-MM/DD/YYYY)
26) Reason for Leaving Previous Residence
27) Did You Give Notice for Leaving?
28) Were You Ever Asked to Move? If Yes, Why?
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29) Name(s) on Current Utility Bills
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30) Please State Your Average Water Bill
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31) Please State Your Average Electric Bill
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32) Have You Ever Been Served a Late Rent Notice?
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33) Is Your Last Rent Amount Paid in Full?
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34) Requested Move-In Date
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35) How Long Do You Plan to Rent A Home?
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36) Current Employer
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37) Current Employer Street Address, City, State, Zip Code
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38) Current Employer Phone Number
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39) Current Job Title
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40) Current Supervisor Name
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41) Current Monthly Gross Pay
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42) Employment Date (MM/DD/YYYY-MM/DD/YYYY)
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43) Previous Employer
44) Previous Employer Street Address, City, State, Zip Code
45) Previous Employer Phone Number
46) Previous Job Title
47) Previous Supervisor Name
48) Previous Monthly Gross Pay
49) Previous Employment Date (MM/DD/YYYY-MM/DD/YYYY)
50) How Many Pets Do You Have? List Type(s) and Breed(s) And State if A Pet is A Doctor Recommended Pet.
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51) Do You or Any Others Listed on the Application Smoke?
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52) Have You Had Any Reoccurring Issues in Your Last Rental?
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53) Have You Had Any Issues With Your Last Landlord?
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54) Are You Interested in Renting Furniture from Us If Available?
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55) Will Someone Else Be Responsible for Rent Payments? If So, Please List Name(s)
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56) Do You Plan to Obtain Renter’s Insurance?
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57) Have You Ever Filed for Bankruptcy? If So, When?
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58) Have You Ever Been Arrested? If So, Why?
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59) Have You Ever Been Involved in a Lawsuit? If So, When?
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60) If You Do Not Have a Housing Authority Voucher, Do You Plan to Apply for One?
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61) Do You Currently Have a Housing Authority Voucher? If Yes, Please Type "Yes" and State Your Last Known Voucher Amount. If No, Please Answer "No" and Then Skip To Number 66 To Provide Your Vehicle Information.
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62) Housing Authority Case Manager Name (If Applicable)
63) Housing Authority Case Manager Phone Number (if Applicable)
64) Housing Authority Email Address (If Applicable)
65) Housing Authority Case Manager city and State (If Applicable)
66) Make of Vehicle #1
67) Model of Vehicle #1
68) Year of Vehicle #1
69) License Plate of Vehicle #1
70) License Plate State of Vehicle #1
71) Vin Number of Vehicle #1
72) Make of Vehicle #2
73) Model of Vehicle #2
74) Year of Vehicle #2
75) License Plate Number of Vehicle #2
76) License Plate State of Vehicle #2
77) Vin Number of Vehicle #2
I believe that the statements I have made are true and correct, and understand that applications are processed on a first come-first serve basis. I authorize verification of information I provide (via background check) and communication with any and all names listed on this application. I understand that a third party source may be used to verify my information for consideration, that my most current email address is required and provided on this application to be used for this purpose, and that the necessary information will be provided if prompted (within 5 business days) for verification purposes. I understand that I am to submit copies of two forms of I.D. (driver's license, social security card, birth certificate, employee I.D. and / or passport) and copies of two most recent pay stubs to info@Collins2Collins.com with my name and birthdate in the subject line of the email. I understand that I am to send a nonrefundable application fee of $40.00 plus state tax and/processing fees online in order to be considered. I understand that each applicant of age 18 and older must complete a separate application and must provide all additional information and payments separately. I understand that if I have a pet that was recommended by a doctor, I must submit a letter from only that doctor along with this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for a home rental and does not constitute a rental or lease agreement in whole or in part. Lastly, I am aware that any questions regarding rejected applications must be submitted in writing, dated, and signed with my signature.
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Electronic Signature (Please State Your Full Name)
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Date
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