Application for Residence

Please fill out the following form if you wish to reside in a Bloomington Rentals and Management property. If any field is left blank, your application may not be processed.

**Application Fee - $45 per applicant. Must be paid prior to application being reviewed.**

Applicant Information

(each applicant is required to complete this form)

Property of Interest:
Preferred Date of Move-In:
Name:
Date of Birth:
Email Address:
Cell Phone Number:
Work or Other Phone Number:
Married and together?
Driver's License #:
Social Security Number:

Present Landlord

Present Address:
Current Rent:
How long at this address?
Current Landlord:
Current Landlord Phone:
Current Landlord Email:
Reason for moving:

Student Info

Are you a full time student?
If student, major field of study and graduation date:
Who pays your rent?

Employment

Employer:
Employer Address:
Employer Phone:
Supervisor:
Occupation:
Hours per week:
Salary/Income (amount AND specify per week/month/year):
Years employed here:

Monthly Expenses

Car Loan Lien Holder:
Balance:
Monthly Payment:
Credit Card Company #1:
CC #1 Balance:
CC #1 Monthly Payment:
Credit Card Company #2:
CC #2 Balance:
CC #2 Monthly Payment:
Child Support or Other Debt:
Other Balance:
Other Monthly Payment:

Vehicle(s)

Make/Model:
License Plate #:
Color:
Year:

In case of emergency!

Name:
Phone:
Complete Address:
Relationship:

Legal Information

Have you ever been sued for bills?
Have you ever been bankrupt?
Have you ever been convicted of a felony?
Have you ever broken a Lease?
Have you ever been locked out of your apartment by the sheriff?
Have you ever been brought to court by another landlord?
Have you ever moved owing rent or damaged an apartment?
If yes to ANY above, please explain why:
Is the total move-in amount available now (rent and deposit)?

Final Information

How did you hear about this rental unit?
Do you smoke?
Do you have pets?

If you select Yes to the Pets question, please note you are agreeing to the Pet Agreement. List all pets including their breed, color, size, and other pertinent information.

Applicant authorizes the landlord to contact past and present landlords, employers, creditors, credit bureaus, neighbors, and any other sources deemed necessary to investigate applicant. All information is true, accurate, and complete to the best of applicant's knowledge. Landlord reserves the right to disqualify tenant if information is not as represented or $35 application fee is not received promptly. ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME.

Sign Initials Here (in lieu of written signature):

To verify you are a human and not spamming, what is the zip code of our address at top-right?