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Form 996-D Rental Application |
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Wisconsin Legal Blank Co., Inc. |
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Milwaukee, Wisconsin |
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Clear Data |
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Print Record |
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Page 1 of 2 |
1 |
RENTAL |
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• Each adult applicant (18 years of age or older) must complete an application. |
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• Incomplete applications will not be considered. |
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• Your application will be denied if you misrepresent any information in this application. |
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APPLICATION |
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54 |
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• Please print legibly. |
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Import Data |
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• Proof of identification is required. |
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Proof of Identification is required.
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Name of Landlord/Agent: |
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UNIT INFORMATION (To be Completed by Landlord) |
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9 |
Address |
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Unit No. |
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Monthly Rental Amount |
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Security Deposit Amount |
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11Type of Tenancy (i.e. 12 month lease, month to month, etc.)
12Utilities Included
13 |
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PERSONAL INFORMATION |
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14 |
Applicant’s Full Name |
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Date of Birth |
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FIRST |
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MIDDLE INT. |
LAST |
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15 |
List any prior names |
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16 |
that you have used: |
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Soc. Sec. No. |
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17 |
Address |
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Phone |
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18 |
City, State, Zip |
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Other Phone |
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19 |
D.L. No. |
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E-mail |
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20 |
OTHER OCCUPANTS include full names. |
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RELATIONSHIP |
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DATE OF BIRTH |
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SOC. SEC. NO. |
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24 |
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RENTAL HISTORY |
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25 |
Current Address |
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How Long? |
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CITY |
STATE |
ZIP |
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26 |
Current Landlord |
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Phone |
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27 |
Reason for Moving? |
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Current Rent Amount ___________ / _______ |
28 |
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29 |
Previous Address |
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How Long? |
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CITY |
STATE |
ZIP |
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30 |
Previous Landlord |
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Phone |
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31 |
Reason for Moving? |
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Current Rent Amount ___________ / _______ |
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32 |
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EMPLOYMENT HISTORY |
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33 |
Current Employer |
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Starting Date |
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34Address
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CITY |
STATE |
ZIP |
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Job Title |
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Gross Monthly Income |
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Supervisor |
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Phone |
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(before deductions) |
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37 |
Other Employer |
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Starting Date |
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38Address
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CITY |
STATE |
ZIP |
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Job Title |
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Gross Monthly Income |
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(before deductions) |
40 |
Supervisor |
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Phone |
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10/26/15 - Drafted by Attorney Tristan R. Pettit of Petrie & Stocking S.C. |
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© 2015 Wisconsin Legal Blank Co., Inc. |
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Wisconsin Legal Blank Co., Inc. • 749 N. 37th Street • |
Milwaukee, WI 53208 • 800-890-6890 • www.wilegalblank.com |
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42List any additional income to be considered – verification required
CREDIT & FINANCIAL INFORMATION
45 |
Bank |
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Account No. |
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Account Type |
46 |
Bank |
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Account No. |
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Account Type |
47Credit References (auto loans, personal loans, credit cards)
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Type |
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Name of Creditor |
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Account No. |
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49 |
Total Amount Owed |
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Monthly Payment Amount |
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50 |
Type |
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Name of Creditor |
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Account No. |
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51 |
Total Amount Owed |
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Monthly Payment Amount |
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52 |
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OTHER INFORMATION |
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53Automobiles and Other Vehicles
54 |
Make and Type |
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Year |
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Color |
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Lic. No. |
55 |
Make and Type |
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Year |
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Color |
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Lic. No. |
56 |
Make and Type |
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Year |
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Color |
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Lic. No. |
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57 |
Do you have any pets? |
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If yes, what type and how many? |
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58 |
Do you own furniture? |
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Do you smoke? |
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59 |
Have you ever been evicted? |
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If yes, please provide circumstances: |
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60
61Emergency Contact:
62 Name |
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Phone |
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Relationship |
63Address
64NOTICE: You may obtain information about sex offender registry and persons registered with the registry by contacting the
65Wisconsin Department of Corrections on the Internet at http://offender.doc.state.wi.us/public/ or by phone at 877-234-0085
66The rental of this property is limited to the use and occupancy by the individuals listed above without any right to sublet any or all of the property.
67Tenant may request in writing within seven days after delivery of the rental unit a list of physical damages or defects, if any, charged to the
68previous tenants security deposit.
69I enclose the sum of $ _______________ (not to exceed $20) for the purpose of purchasing my consumer credit report.
70I understand that if I have misrepresented any information on this application that my application will be denied.
71I authorize Landlord to do the following: (1) contact any individuals and/or businesses listed above and verify all of the information provided
72in this application before, during, and/or after my tenancy, and (2) obtain a copy of my consumer credit report.
73I acknowledge being furnished copies of the Rental Agreement, Rules & Regulations, and if applicable, any Nonstandard Rental Provisions.
74I agree to sign the Rental Agreement, Rules & Regulations and Nonstandard Rental Provisions, if applicable, prior to taking occupancy of
75the unit.
76I certify that all of the information provided in this application is true and accurate to the best of my knowledge.
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79 Signature of ApplicantDate
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NOTE: A SECURITY DEPOSIT IS REQUIRED FROM EVERY TENANT AGAINST DAMAGE OR LOSS TO THE PREMISES AND THE SECURITY DEPOSIT CANNOT BE USED FOR THE LAST MONTH’S RENT.
82Please Note: Landlord is using public records provided by a third party service to determine your eligibility to rent. Neither Landlord, nor
83the third party service, can vouch for the accuracy of the records as they have no control over such records. It is the responsibility of the
84applicant to check the accuracy of their own public records.
10/26/15 - Drafted by Attorney Tristan R. Pettit of Petrie & Stocking S.C. |
© 2015 Wisconsin Legal Blank Co., Inc. |
Wisconsin Legal Blank Co., Inc. • 749 N. 37th Street • Milwaukee, WI 53208 • 800-890-6890 • www.wilegalblank.com