**Please fill out this form as completely as possible to prevent your application from being declined due to incompleteness. If a certain question does not apply to your situation, please put N/A in the corresponding blanks. If we cannot fully investigate your rental/employment/banking history due to lack of information, your application could be declined without refund of any application fee.

Primary Applicant

Full Name (include middle inital)
Home/Cell Phone (with area code)
Other Phone (with area code)
Date of Birth
Email Address


Full Name (include middle inital)
Home Phone (with area code)
Date of Birth


Name of Dependents
Dependents Date of Birth
List all Pets

Residential History (Last 3 Years)

Current Address
Apt #
Month/Year Moved In
Reason for Leaving
Phone (with area code)
Previous Address (Last 3 years)
Phone (with area code)

Please describe your credit history

Have you declared bankruptcy in the past seven (7) years?
Have you ever been evicted from a rental residence?
Have you had two or more late rental payments in the past year?
Have you ever willfully or intentionally refused to pay rent when due?

Please provide your employment information

Your employment status
Date Employed
Employed as
Supervisor Name
Supervisor Phone

Additional Informaiton

Where may we reach you to discuss this applications?

Day Phone (with area code)
Night Phone (with area code)

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application, I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent’s cost, time, and effort in processing my application.

I hereby deposit $___________ as earnest money to be refunded to me if this application is not accepted in 3 business banking days. Upon acceptance, this deposit shall be retained as part of the security deposit. When so approved and accepted, I agree to execute a lease for __________ months before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct. I hereby authorize Urban Equity Properties, LLC or its agents to verify the above information and obtain either a consumer or investigative report from Screening Reports, Inc. I understand that the $25 fee for verifying this rental application is not a deposit, and will not be refunded even if the application to rent is declined.

 I agree to permit an investigation of my credit, tenant history, banking and employment for the purposes of renting an apartment with this owner/manager.


Please check the box below to complete your request.