Application for Rental

Before submitting this form, please read the Missouri Real Estate Commission Broker Disclosure Form.

(Each Co-Applicant Must Submit Separate Application)

Property Applying For:
Name   Name of Spouse (if applicable)
Present Address   City    State   Zip
How Long
Home Phone   Cell Phone   Email
Present Landlord/Lender        
Previous Address   City    State   Zip
How Long
Previous Landlord/Lender        




SPOUSE (if applicable)

Date of Birth Date of Birth
Social Security Social Security
Driver's License No. Driver's License No.
Present Employer Present Employer
Address Address
How Long Employed How Long Employed
Position Position
Name of Supervisor Name of Supervisor
Monthly Income Monthly Income
Business Phone Business Phone
Business Fax Business Fax
Business E-mail Business E-mail
Prior Employer Prior Employer
Address Address
Supervisor/Phone # Supervisor/Phone #
Monthly Earnings Monthly Earnings
How Long Employed How Long Employed

Savings Acct:    Yes   No  Name of Bank   Acct.#
Checking Acct: Yes   No  Name of Bank   Acct.#

Auto:  Year   License   Make
Auto:  Year   License   Make
Auto:  Year   License   Make

Have you and/or your spouse (if applicable) ever been arrested?   Yes   No
If so, when and what for?

Do you have any pets? Yes   No
Kind, Weight, Breed and Age

Name    Address    City
State    Zip    Phone
Relative who can be contacted in case of emergency/death:
Name    Address    City
State    Zip    Phone    Cell Phone
How you were referred to us: Drive By   Referral   For Rent   Apt. Guide   Other

Desired move-in date    Desired lease term   


By checking this box applicant(s) acknowledges that they have received and read the Missouri Real Estate Commission Broker Disclosure Form.

It is fully understood that if application is approved, any deposit which is made with the application will be held as security for the performance of the convenants of the lease and as a damage deposit and the full security deposit will be determined. It is further understood and agreed that all applications are subject to approval and acceptance of the agent and are the property of the agent (and inclusive of the results there of) and not the applicant. If applicant(s) withdraws this application, the applicant(s) agrees that the deposit may be accepted by the agent as a fee for processing the application (Applicant(s) has 72 hours to resend, in writing, this application, at which time a deposit will not be forfeited). An application fee to be determined (which is non-refundable) must accompany this application.

Applicant(s) hereby authorizes Lessor to procure a "consumer report" as defined in the Fair Credit Reporting Act, 15 U.S.C. 1681 a(d), seeking information on the credit-worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living of applicant(s). I also agree and understand that Lessor may obtain additional consumer reports on me in the future to update or review my account. I understand that my application may be rejected if during the investigation there are found to be judgements, lien(s) or bankruptcy in my personal credit history. I hereby authorize Lessor to obtain information it deems desirable in the processing of my application for residency, including: credit reports, civil or criminal actions, rental history, employment/salary details, police and vehicle records, and any other relevant information; and release Lessor, its employees and agents from all liability for any damage whatsoever incurred from furnishing or obtaining such information.

By checking this box applicant(s) acknowledges that they agree with these terms.


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