Online Rental Application

Please complete the following form and click [Send Message].

Primary Applicant Info.

Primary Applicant Name:

Date of Birth:

Day Phone Number:

Evening Phone Number:

SS# Social Security Number:

Drivers License #:

Email Address:

Present Occupation:

Employer Name:

Employer Phone #:

How long at this job?:

Current Monthly Income:

Spouse's Income:

Other Income:

Co Applicant Info.

Co Applicant Name:

Date of Birth:

Day Phone Number:

Evening Phone Number:

SS# Social Security Number:

Drivers License #:

Email Address:

Present Occupation:

Employer Name:

Employer Phone #:

How long at this job?:

Current Monthly Income:

Spouse's Income:

Other Income:

Current Residence

Present Address:

How long at the address?:

Current Monthly Rent:

Reason for moving:

Current Landlord:

Landlord Phone #:

Do you have pets?:

Describe Pets:

Personal References (Name, Address, Phone):

Emergency Contacts (Name, Address, Phone):

Previous Landlords

Please provide 3 formler landlords, the property addresses, and the landlord phone numbers:

Occupant's Information

Name/DOB/Relationship of all occupants:

How many total people will be living in unit?:

When will you be able to move in?:

When will you have the "Move In" money required?:

Have pets caused any past injury or damage? (describe):

Background Information

1. Have you ever been evicted for NON-PAYMENT of rent?:

2. Have you ever been evicted for any other reason?:

3. Have you ever had a judgement file against you for NON-PAYMENT of rent or for damages to rental unit?:

Have you ever been arrested and/or convicted for rape, arson, physical abuse, prostituion, or illegal drugs?:

5. Have you ever been convicted of a felony?:

6. Have you ever been sued by a landlord for any reason?:

7. Have you ever received a 30-60 day notice from a landlord/manager?:

Do you (or any intended occupant) smoke?:

9. Do you have any water filled furniture? (waterbed, aquariums, etc.):

10. Did you give your current landlord/manager a 30 day notice?:

11. Have you ever filed for bankruptcy?:

12. Have you ever received a violation notice for noise, traffic, or garbage from a landlord/manager?:

13. Do you have an Oregon Medicinal Marijuana user and/or grower card?:

The above applicant(s) hereby certify that the above information is true and correct.

Applicant(s) understand that inaccurate, incomplete, or false information is grounds for denial of the application and could result in termination of tenancy and/or loss of security deposit.

Applicant(s) also authorize the verification of all references given and a credit check on each applicant.

Signature: By typing my name below, I certify that I am the applicant and/or co-applicant named above, and I/we consider this my/our legal signature to this rental application.

Your Signature:

Your Name:

Your Email:

Your Phone:

Security Code:

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