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Application to Lease
Property Information
Please be sure to input information according to the hints (in small letters).
Rental Property Address*  
Rental Amount  
Notes/Special Considerations  
Personal Information (one application per person over 18)
Last Name:*  
First Name:*  
Middle Initial:  
Social Security #  
xxx-xx-xxxx
Date of Birth:*  
xx/xx/xxxx
If your SS# is not provided, we will call you for the number.
E-Mail:*  
Cell/Primary Phone:  
Text*  
Yes No 

Alternate Phone:  
Text*  
Yes No 

Work Phone:  
Drivers License Number or Valid ID & State*  
R-XXXXXX - CA
Exp Date*  
xx/xx/xxxx
Smoker?*  
Yes No 

All Other Occupants
List all other occupants, including names and relationships
List All Occupants*  
i.e. Tim 16, (son)
Pets
List all Pets by type, age, name.weight
  
i.e. Dog, 15, Sassafras 5lb
Residence History
Current Address*  
Address Line 2:  
City:*  
State:*  
Zip:*  
Current Address-Date From/To  
to*  
Prop Mgr/Owner Name:*  
Prop Mgr/Owner Phone:*  
Prop Mgr/Owner email:  
Current Rent:*  
Numerals only please
Utilities Included?  
Water Electric Other 

Rent Paid Through:*  
xx/xx/xxxx
Reason for leaving:  
___________________________________________________________________________________________
Previous Address Line 1:*  
Address Line 2:  
City:*  
State:*  
Zip Code:*  
Previous Address-Date From/To  
Previous Address-Date From/To  
to*  
Prop Mgr/Owner Name:*  
Prop Mgr/Owner Phone:*  
Prop Mgr/Owner email  
Rent:*  
Numerals only please
Utilities Included?  
Water Electric Other 

Reason for leaving:  
Reference/Emergency Contact Information
Name*  
Relationship*  
Phone*  
Email*  
Name*  
Relationship*  
Phone*  
Email*  
Employment or Income Source
Current Occupation/Status:*  
clerk, disabled, retired.
Start Date:*  
xx/xxxx
Employer or Income Source*  
Company / SSI / HSA
Business Address:*  
Type of Business:*  
Position Held:*  
Supervisor Name & Title:*  
Supervisor Phone:*  
Monthly Gross Income:*  
Numerals only please
Additional Gross Income:*  
Numerals only please
Savings
Bank Name:*  
i.e. BofA - Checking
Account Number:  
last 4 digits
Balance:*  
Numerals only please
BankName:  
BofA - Checking
Account Number:  
last 4 digits
Balance:  
Numerals only please
Credit Reference
Credit Account Name:*  
Account Number:  
Balance:*  
Numerals only please
Credit Account Name:  
Account Number:  
Balance  
Numerals only please
Vehicles
1) Car Make & Model:*  
Production Year:*  
Color:*  
License Plate Number:*  
2) Car Make & Model:  
Production Year:  
Color:  
License Plate Number:  
Question & Answer (as applicable)
Rate Your Neatness (for tenants only):*  
Compulsively Neat
Very Neat
Moderately Neat
Not Very Neat
Slob

Ever Filed for Bankruptcy?*  
Yes No 

Ever been evicted?*  
Yes No 

Ever refused to pay rent?*  
Yes No 

Requested Move In Date:*  
xx/xx/xxxx
I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AUTHORIZE ITS VERIFICATION AND THE OBTAINING OF A CREDIT REPORT.
Applicant understands and agrees: (1) this is an application to rent only and does not guarantee that applicant will be offered the Premises; and (2) Landlord, Manager, or Agent may accept more than one application for the Premises and, using their sole discretion, will select the best qualified applicant. Applicant represents the above information to be true and complete, and hereby authorizes Landlord or Manager or agent to verify the information provided and obtain credit report on applicant. If application is not fully completed or received without the screening fee: the application will not be processed fully, and the application will be returned.
I agree that the Landlord may terminate any agreement entered into in reliance on any misstatements made above.
Dated:*  
xx/xx/xxxx
By entering my first & last below, I agree to all of the terms and conditions stipulated on this application.
Signature:*  
First Name
  
Last name
Home Viewing Application
  Hold my application until I select a home
T
Processing Application Fee
  Fee per adult over 18 -
T
Grand Total:  
______________________________________________________________________________________________
Questions or comments: Text (209) 628-9231
Lane Property Management & Realty
P.O. Box 2365
Merced, CA 95344-2365
Fax 209 725-0351
email: LanePropertyMgmt@gmail.com
 

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