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There is a $25.00 application fee per person over the age of 18
DATE:____________________
Applicant’s Full Name: ______________________________________________________________________________
Present Address: ________________________________________________ Phone: (_____) ______________________
City: __________________________ State: _______ Zip: ____________ Cell Phone: (_____) ______________________
Social Security Number: _____________________________________________ Date of Birth: _____________________
Driver’s License Number: __________________________________ Email: ____________________________________
Co-Applicant Name: ________________________________________________________________________________
Present Address: ________________________________________________ Phone: (_____) ______________________
City: __________________________ State: _______ Zip: ____________ Cell Phone: (_____) ______________________
Social Security Number: _____________________________________________ Date of Birth: _____________________
Co-Applicant D/L Number: _________________________________ Email: ____________________________________
How Many Persons will occupy this apartment (including self)? _______________ Please list below.
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| Name Age Relationship | Name Age Relationship | |
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| Name Age Relationship | Name Age Relationship |
Current Employer: __-_______________________________________________________________________________
Present Address: ______________________________________________________ Phone: (_____) ________________
Supervisor’s Name: ______________________________________ Employed From: _______________To: ___________
Position: ____________________________________________ Salary: ______________________ week / month / year
Co-Applicant Employer: _____________________________________________________________________________
Address: _____________________________________________________________ Phone: (_____)________________
Supervisor’s Name: ______________________________________ Employed From: _______________To: ___________
Position: ____________________________________________ Salary: ______________________ week / month / year
If less than 1 year at current employer, list previous employers and phone numbers:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Current Landlord: ___________________________________________________ Phone: (_____) __________________
Landlord’s Address: _________________________________________ How long at this address: ___________________
If Current Landlord is Less Than One Year or Currently Not Renting, Please Give Previous Landlord:
_________________________________________________________________________________________________
Address Rented: ___________________________________________________ Dates Rented: ____________________
Co-Applicant Landlord: ______________________________________________ Phone: (_____) __________________
Landlord’s Address: _________________________________________ How long at this address: ___________________
If Current Landlord is Less Than One Year or Currently Not Renting, Please Give Previous Landlord:
_________________________________________________________________________________________________
PROPERTY INTERESTED IN: __________________________________________ DATE NEEDED: ___________________
Do you have a pet? _________________ What Type? ______________ Weight? __________ Age: _________________
Have you ever filed for bankruptcy? _____________________ Been evicted from tenancy? ________________________
Late on your rent payments? _______________________ Refused to pay rent when it was due? ____________________
Been convicted of a felony? _____________ Smoker? _________ Who referred you to TV Realty? __________________
Applicant: Who to contact in case of emergency: __________________________ Phone: (_____) __________________
relationship: ____________________________ address: __________________________________________________
Co-Applicant: Who to contact in case of emergency: ________________________ Phone: (_____) __________________
relationship: ___________________________ address: ___________________________________________________
Phone: 815-378-7962 - Fax: 815-748-3485
I hereby authorize my Landlord / Employer and / or credit agency to disclose the information requested below to Tv Realty.
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| Applicant name (print) | Applicant signature | Social Security Number |
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| Co-Applicant name (print) | Co-Applicant signature | Social Security Number |
Please return the application to TV Realty. We will contact your landlord / employer for further information. Thank you.
From: TV Realty
The applicant referenced above has applied for rental property and has indicated you as their Landlord / Employer. Please complete the following information and return it to us at your earliest convenience.
I. Landlord Address: ___________________________________________________________________
Lease Dates: ___________________________________________________________________________
How many people signed to the lease: __________________________________________________________
Rent Amount: $___________________________ Security Deposit: $________________________________
Amount of past due balance: $_______________________________________________________________
Number of late payments: __________________________________________________________________
Number of NSF checks in the last 12 months: ____________________________________________________
Have any unauthorized persons lived in this unit: _________________________________________________
Has this resident been found with a pet: _____________________________ Is it permitted: _______________
Have there been any noise problems: __________________________________________________________
Have the police been called regarding the applicant or guests: ________________________________________
If yes, please explain: _________________________________________________________________
Has the applicant or guests acted in a physically violent or verbally abusive manner toward neighbors or staff: _______
If yes, please explain: _________________________________________________________________
Amount of security deposit refunded to tenant: $__________________________________________________
Please explain: ______________________________________________________________________
Would you rent to this resident again: __________________________________________________________
Other problems: _________________________________________________________________________
Are you related to this applicant: ________________________________ If yes, how: ____________________
II. Employer Employee Name: _____________________________________________________________
Starting date: ___________________________________________________________________________
Salary: ________________________________________________________________________________
Continued Employment expected: _____________________________________________________________
Are you related to this applicant: ________________________________ If yes, how: _____________________
III. Landlord / Employer – Thank you for your assistance!
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| Signature | Title | Date |