Rubey Realty

Required Fields

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, Pet Weight, Special Requirements, etc.):
Characters: (300 remaining)
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, Pet Weight, Special Requirements, etc.):
Characters: (300 remaining)
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:
Characters: (300 remaining)

Date Lived:	-
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:
Characters: (300 remaining)

Applicant Past Residence:

Co-applicant Past Residence:

Date Lived:	-
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:
Characters: (300 remaining)

Date Lived:	-
Current Address:
City:
State:
Zip:
Owner / Agent:
Owner Phone #:
Monthly Rent:
Reason for Leaving:
Characters: (300 remaining)

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 "Yes" Responses Above:
Characters: (300 remaining)

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:

Characters: (300 remaining)

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:

Characters: (300 remaining)

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:

Characters: (300 remaining)

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.):

Characters: (300 remaining)

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.

Serving Southwest Iowa since 1956

Rental Application Form

Rental Property Interested In:

Applicant Information:

Co-applicant Information:

Residential Information (Last 3 Years):

Applicant Current Residence:

Co-applicant Current Residence:

Applicant Past Residence:

Co-applicant Past Residence:

Credit History:

Employment Information:

Applicant Current Employment:

Co-applicant Current Employment:

Applicant Past Employment:

Co-applicant Past Employment:

References:

Please list two references:

Personal Reference or Emergency Contact:

Additional Information:

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

	Serving Southwest Iowa since 1956
	Home Our Listings Acreages Commercial Farms Lots Residential MLS Rentals Rental Application Apartment Commercial House / Duplex Auctions Agents About Us Contact Us