Walt
Flood Realty
1750
Kalakaua Ave., Suite 103
Honolulu,
HI 96826-3795
RENTAL
APPLICATION
Deposit Amount Paid
$____________ Date:
__________________ Received
By: ___________________
For rental unit located at:
__________________________________________________ Desired Move-In
Date__________
Name of Applicant:
_______________________________________________________SSN:
________________________
Name of Co-Applicant:
____________________________________________________SSN:
_______________________
Current Resident Phone:
_______________ Business Phone: _____________ Other Phone/E-mail:
____________________
Name of Additional
Occupants: _____________________________________________ SSN:
_______________________
_______________________________________________________________________
SSN: _______________________
Present Address:
____________________________________________ City/State/Zip:
_____________________________
From/To:
___________/____________ Rent Amount: $_____________ Reason for moving:
_________________________
Landlord’s Name:
___________________________________________ Landlord’s Telephone:
______________________
Previous Address:
___________________________________________ City/State/Zip:
_____________________________
From/To: ___________/____________
Rent Amount: $_____________ Reason for moving: _________________________
Landlord’s Name:
___________________________________________ Landlord’s Telephone:
______________________
Applicant’s Current
Employer: ________________________________ Position Held: _____________________________
Employer’s Address:
________________________________________ Date Employed: ____________ Salary: $________
Supervisor’s Name:
_________________________________________ Supervisor’s Telephone: _____________________
Previous Employer:
_________________________________________ Position Held: _____________________________
Employer’s Address:
________________________________________ Date Employed: ____________ Salary: $________
Supervisor’s Name:
_________________________________________ Supervisor’s Telephone: _____________________
Co-Applicant’s Current
Employer: _____________________________ Position Held: _____________________________
Employer’s Address:
________________________________________ Date Employed: ____________ Salary: $________
Supervisor’s Name:
_________________________________________ Supervisor’s Telephone: _____________________
Previous Employer:
_________________________________________ Position Held: _____________________________
Employer’s Address:
________________________________________ Date Employed: ____________ Salary: $________
Supervisor’s Name:
_________________________________________ Supervisor’s Telephone: _____________________
Source of Other Income:
______________________________________ Amount:
$________________________________
Verifiable by:
______________________________________________ Telephone: _______________________________
Bank Name:
_______________________________________________ Checking Account #: _______________________
Bank Name:
_______________________________________________ Savings Account #: _________________________
Personal Reference:
_________________________________________
Telephone: _______________________________
Address: __________________________________________________ Relationship:
______________________________
Personal Reference:
_________________________________________
Telephone: _______________________________
Address:
__________________________________________________ Relationship: ______________________________
In Case of Emergency,
Notify: _________________________________ Telephone:
_______________________________
Address:
__________________________________________________ Relationship: ______________________________
I hereby give my permission
for you to perform a criminal background check. I have read the above form and
I understand that if I cause a financial loss to my landlord, my name my be
placed in the files of the Credit Bureau of the Pacific, Inc. (Equifax System
Affiliate) and such information will be furnished to subscribers who have a
bona fide and legal need to make an inquiry. I also understand that causing a
financial loss may limit my ability to obtain credit or lease other dwelling
units. I hereby authorize consumer-reporting agencies to provide you with
consumer reports relating to me. I hereby give my permission for you and Credit
Bureau of the Pacific, Inc. (Equifax System Affiliate) to verify the above
information.
Applicant Signature:
_________________________________________ Date:
____________________________________
Applicant Signature: _________________________________________ Date: ____________________________________