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Illinois Rental Application Form

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Illinois Rental Application Form Page 2
Illinois Rental Application Form
Annual Income
Include the gross amount of all salaries, fees, commissions, tips, overtime of other employment earnings
Applicant Co-Applicant Other Other
Base Pay _______________ _______________ _______________ _______________
Overtime _______________ _______________ _______________ _______________
Commissions _______________ _______________ _______________ _______________
Tips _______________ _______________ _______________ _______________
Other _______________ _______________ _______________ _______________
Current Liabilities
Creditor Account # Amount Owed # of Payments left Monthly Amount
Personal References
name address city telephone
name address city telephone
Bank References
bank name address city telephone
bank name address city telephone
Has anyone who will reside in the apartment ever been convicted of a felony yes no
if yes explain below
A deposit in the amount of $ is made herein to be applied to the first month’s rent and security deposit.
This deposit will be held during the processing of this application. If the application is approved and accepted, then
applicant(s) agree to execute a written lease and pay the balance due on the first month’s rent and security deposit
within ten (10) days after being notified. If the applicant(s) fail to execute the lease and make payments as aforesaid
then the deposit will be retained as liquidated damages to cover the cost of processing this application. If this
application is not approved and accepted, the deposit will be promptly refunded.
In addition to the deposit, the sum of $ is hereby paid to cover the cost and expense of obtaining a credit
report on the applicant(s); the sum is not refundable. Applicant(s) understand that the filing of this application does
not bind the Lessor to reserve or assign an apartment.
The undersigned applicant(s) has examined the statements made in this application and hereby certify that they are
true, correct and complete and that all household income has been listed above. The statements are made to induce
the Lessor to enter into a lease with Applicant(s) for the apartment listed above. I/We agree that inquiries may be
made to verify the statements made in this application.
Signature of Applicant Date
Signature of Co-Applicant Date
Illinois Rental Application Form