Rental Application

Thomas C Veatch, Owner
Today's Date:________________
Lease Begins:________________
Lease Ends:________________
Address:1210 NE 124th St., Seattle WA 98125
Monthly Rent:$_______
Security Deposit:$_______
Lease Ends:________________
Each adult applicant must provide photo ID and read our Resident Manual.
We do NOT rent to anyone whose references we cannot contact.
We do NOT allow anyone to move in immediately.
Personal Information
Applicant's Full Name____________________________ SSN _____ - ___ -______ Birth Date ______ ___
Present Address _________________________ City _______________ State___ Zip ________________
DL#/State Issued ___________________ Tel # (      )______-_______ Email ______________________
Landlord Name ____________________ Landlord Phone(      )____-________ Date moved in _______
Marital Status (circle one) Single Married Separated Divorced Current rent amount _________
Are you paying alimony? __ No __ Yes, $_______ paying child support? __No __Yes , $_______
s Full Name____________________________ SSN _____ - ___ -______ Birth Date ______ ___
Dependent Name_____________ Birth Date _____Dependent Name______________ Birth Date ____

Resident History (We need the past 3 years. If more space is needed, use the back.)
Previous Address, City, State, Zip __________________________________________________________
Landlord Name ____________________________ Mo/Yr Moved In _______ Mo/Yr Moved Out _______
Landlord Phone (      )____-________ Reason for leaving __________________________ Rent $______
Previous Address, City, State, Zip __________________________________________________________
Landlord Name ____________________________ Mo/Yr Moved In _______ Mo/Yr Moved Out _______
Landlord Phone (      )____-________ Reason for leaving __________________________ Rent $______

Employment Information (If you are not currently employed, list most recent employer.
If you have more than one employer or spouse is employed, use the back.)
Employed: (circle one) Full-time Part-time Unemployed Retired Student. Start Date __/__/____
Employed by: _______________________________________ (check one) Current __ Past __
Employer's Address ____________________________________________ Phone (      )____-________
Job/Position___________________ Income $_______ per_____ Employer's Name_________________
If student, where: _________________________ Advisor _____________ Phone (      )____-________
Major ____________________________ Present year (circle one) FR SOPH JR SR GRAD

Other Information
Local Contact _______________________ Address___________________ Phone (      )____-________
Nearest Relative_____________________ Address___________________ Phone (      )____-________
Emergency Contact __________________ Address___________________ Phone (      )____-________
Disability status and require special accommodations?_________________________________________
Bank_______________________ Acct#_________________ Branch___________ Tel#(      )____-_____.
Additional Income (Interest, Child Support, Etc.)_____________________________________________
Primary Vehicle Make/Model/Color _____________________ Yr____ License #___________ State ____
Second Vehicle Make/Model/Color _____________________ Yr____ License #___________ State ____
Other vehicles_________________ _____________________ Yr____ License #___________ State ____
Ever been evicted or refused to pay rent? __ No __ Yes. Ever filed bankruptcy?__No __Yes
Ever been or are you currently an illegal abuser of any controlled substance? __ No __ Yes
Are you a Registered or Unregistered Sex Offender? __No __Yes
If yes, to any of the above, give details. What charge? What county/state? When? _________________
_______________________________________________ _____________________________________
Ever used any other name(s)? __ No __Yes. If Yes list name(s)_________________________________
Do you smoke? __No __Yes Own pets? __ No __ Yes, Type _____ Have a waterbed? __ No __ Yes
Ever had bedbugs or other infestation? If yes, what type of infestation?___________________
Personal References (Please do not use a relative or someone previously listed on this application.)
Name_________________________________ Phone (      )____-________ Relationship____________
Name_________________________________ Phone (      )____-________ Relationship____________

Letter of Authorization:
To Whom it May Concern:
In compliance with the Fair Credit Reporting Act, State and Federal laws, this is to inform you and your household members that an investigation involving the statements made on this application for tenancy is being initiated by ORCA Information Inc., PO Box 277 Anacortes Washington 98221 360-588-1633. I certify that to the best of my knowledge all statements are true and complete. I further authorize to obtain CREDIT REPORTS, EMPLOYMENT REFERENCES (including verifying salary), COURT, CRIMINAL & JUVENILE RECORDS, ARREST DETENTION INFORMATION and CHARACTER REFERENCES, GENERAL REPUTATION, MODE OF LIVING and RENTAL REFERENCES as needed to verify all information put forth on this application and otherwise available regarding all applicants identified on this application (for juvenile occupants, the undersigned parent/guardian authorizes the above-information to be obtained on their behalf).
Furthermore I warrant the accuracy of all information contained on this rental application including that relating to the other intended occupants of the subject property. I understand and agree that if subsequently a determination is made that I provided false or inaccurate information on the rental application it is a breach of the terms of any rental agreement signed based on that information and Owner and/or his/her agent may take legal action to terminate said Agreement.
In addition, I confirm receipt of the Tenant Selection Policy (per WA State Fair Tenant Screening Act, 2012) from this landlord/property management BEFORE submitting this completed rental application and that I read and understand my rights as described therein. I give permission for Owner and prospective co-tenants to receive and view the ORCA report.
I further affirm and acknowledge that: I cannot move in until the application is approved, and the lease (original or as modified) is approved and signed by all parties thereto, and the Security Deposit is paid in full. All rent is due and payable on the 1st day of the month in advance. I/we hereby apply to lease the above described premises on the terms above specified and have deposited $______ earnest money to be refunded to me if this application is not accepted. In the event no verifiable rental history is available, I will increase my deposit to an amount equal to two months rent. I also understand that if I am an undergraduate student I may be required to have a parent co-signature on the lease. If the Owner accepts this application, I understand that I/we are obligated to sign a lease for said premises within seven (7) working days. If I/we fail to sign the lease, all monies paid are to be retained by the Owner as liquidated damages and there shall be no further liability on the part of the Owner or his agent in respect to said proposed lease for this application.

Applicant's Signature ________________________________________________ Date ______________

Application Taken By: Reference Checks By: Approved By:
______________________ _______________________ __________________