Serving Southwest Iowa since 1956

Rental Application Form

See a rental you like?
Fill out the application below or Click here to download an application.

Required Fields

style="display:none;"

Rental Property Interested In:

Anticipated Move Date:
Rental Address:

(If applying for more than 1 location, please put the addresses in the "Notes" section)
Anticipated Rent:

Applicant Information:

Co-applicant Information:

Name:
Birth Date:
Phone #:
Email:  
Tell us about yourself and any special requirements you have

(Dependents Names, Ages, Pets, Special Requirements, etc.):

 
Animals:
(Limit 2 alltogether)
Dog(s):   Cat(s):
Name:
Birth Date:
Phone #:
Email:  
Co-applicant info and any special requirements they have

(Dependents Names, Ages, Pets, Special Requirements, etc.):

 
Animals:
(Limit 2 alltogether)
Dog(s):   Cat(s):

Residential Information (Last 3 Years):

Applicant Current Residence:

Co-applicant Current Residence:

Date Lived:  - 
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:
Date Lived:  - 
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:

Applicant Past Residence:

Co-applicant Past Residence:

Date Lived:  - 
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:
Date Lived:  - 
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:

Credit History:

Have you declared bankruptcy in the past 7 years? Yes: No:
Have you ever been evicted from a rental residence? Yes: No:
Have you had two or more late rental payments in the past year? Yes: No:
Have you ever willfully or intentionally refused to pay rent when due? Yes: No:
Please Explain Any of the Above:

Employment Information:

Applicant Current Employment:

Co-applicant Current Employment:

Employment Status? Full Time:    Part Time:
Student:    Unemployed:
Company?
Dates Employed?
Position?
Supervisor Name?
Supervisor Phone?
Salary Amount?    Per:
Co-Applicant Employment Status? Full Time:    Part Time:
Student:    Unemployed:
Company?
Dates Employed?
Position?
Supervisor Name?
Supervisor Phone?
Salary Amount?    Per:

Applicant Past Employment:

Co-applicant Past Employment:

Past Employment? Full Time:    Part Time:
Student:    Unemployed:
Company?
Dates Employed?
Position?
Supervisor Name?
Supervisor Phone?
Salary Amount?    Per:


If employed by above less than 12 months, give name & phone # of previous employer. If a student, give name and phone # of school(s) where enrolled:
If you have other sources of income that you would like us to consider, please list amount, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to state alimony, child support or spouse’s annual income amounts unless you want them considered in this application:
Co-Applicant Past Employment? Full Time:    Part Time:
Student:    Unemployed:
Company?
Dates Employed?
Position?
Supervisor Name?
Supervisor Phone?
Salary Amount?    Per:


If employed by above less than 12 months, give name & phone # of previous employer. If a student, give name and phone # of school(s) where enrolled:
If you have other sources of income that you would like us to consider, please list amount, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to state alimony, child support or spouse’s annual income amounts unless you want them considered in this application:

References:

Please do not use family / friends. Good examples of references would be co-workers, pastors, etc.

Please list two references:

Reference 1:
Name:
Address:
Phone:
Relationship:
Reference 2:
Name:
Address:
Phone:
Relationship:

Personal Reference or Emergency Contact:

Personal Reference / Emergency:
Name:
Address:
Phone:
Relationship:

Additional Information:

Please give any additional information that might help the owner and/or management evaluate this application

(Phone number and best time of day to reach you, criminal history, past rental issues, etc.):

I hereby state that all information entered in this form is truthful and correct and recognize by clicking "Submit" that Rubey Realty/Rentals will need to obtain more confidential information such as social security numbers, banking information, and driver’s license numbers to complete and finalize the application process.

I recognize that as part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

I agree the above information, to the best of my knowledge, is true and correct.




site by: Community Connections Inc.