NORTH CAROLINA RENTAL APPLICATION
Application
F ee
$ ____
p er
m arried
c ouple/$____
p er
a dult
r oommate.
P lease
f ill
a ll
b lanks;
u nanswered
b lanks
m ay
result
i n
a pplication
b eing
d enied.
T he
a ttached
R ental
V erification
a nd
E mployment
V erification
a re
t o
b e
s igned
b y
t he
applicant
s o
t hat
w e
m ay
c ontact
t he
a pplicant's
c urrent
l andlord
a nd
e mployer
t o
v erify
r ental
a nd
e mployment
s tatus.
The
u ndersigned
h ereby
m akes
t he
a pplication
t o
r ent
t he
p roperty
l ocated
a t:
at
a
m onthly
r ental
a mount
o f
$
Move
i n
d ate
r equested:
Who
S howed
y ou
t he
h ouse:
Contact/Identifying
I nformation
Full
N ame:
D ate
o f
B irth:
S.S.
N umber:
Home
P hone:
C ell:
W ork:
E-‐Mail:
Drive
L icense
#
a nd
S tate:
Spouse
N ame:
D ate
o f
B irth:
S.S.
N umber:
Home
P hone:
C ell:
W ork:
E-‐Mail:
Drive
L icense
#
a nd
S tate:
Vehicle
( make/model):
Y ear:
Tag#:
State:
2nd
V ehicle:
Y ear:
T ag#:
S tate:
Other
V ehicles
( Boats,
e tc):
Do
y ou
o r
a ny
m ember
o f
y our
a pplicant
h ousehold
s moke?
Y es
N o
-‐
N ame(s):
Do
y ou
o r
a ny
m ember
o f
y our
a pplicant
h ousehold
h ave
o r
p lan
t o
a cquire
a
g un
o r
o ther
l icensed
o r
r estricted
w eapon?
Yes
N o
N ame(s):
Do
y ou
o r
a ny
m ember
o f
y our
a pplicant
h ousehold
n ow
h ave
o r
h ave
y ou
e ver
h ad
a
s ubstance
a buse
p roblem
i ncluding
abuse
o f
A lcohol,
u se
o f
i llegal
d rugs,
e tc.?
Y es
N o
N ame(s):
Residence
H istory
(For
p ast
3
y ears,
b eginning
w ith
m ost
c urrent)
Current
H ome
A ddress:
Own?
Y es
N o
M ortgage
$
City:
S tate:
Zip:
Length
o f
s tay
a t
t his
a ddress:
Rental?
Y es
N o
R ent
$ :
L andlord
E mail:
L andlord
P hone: