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Michigan Rental Application Form

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Michigan Rental Application Form Page 2
Michigan Rental Application Form
Additional Income: Child support, alimony, etc
Source:
Amount: per:
VEHICLES
Number of Vehicles on Property:
Do you have any motor homes, vans, boats, or motorcycles If so, specify:
Auto Number 1 Year/Make/Model:
License Plate: State: ______
Auto Number 2 Year/Make/Model
License Plate: State: ______
OCCUPANTS
Total Number of Occupants: _______
List Occupants with Birthdates:
__________________________ ____________ ___________________________ ______________
__________________________ ____________ ___________________________ ______________
EMERGENCY CONTACT
In Case of Emergency Call:
Relationship:
Area-Code Phone:
Address:
In the event of the rental application is approved, the owner or agent may apply the deposit of $
on account of security due or to become
due. If the application is approved and was not cancelled within 3 days (72 hours) but the undersigned chooses not to enter into the lease the deposit will be forfeited as
liquidated damages incurred by the owner as a result of not having been able to rent the apartment to another party during this time.
LEASE INFORMATION
Beginning Date:
Ending Date: Size of Apartment:
Monthly Rental:
Yearly Rental: Move In Date:
Pro Rate:
Security Deposit:
Balance due upon execution of lease by certified check or money order: $
Date:
I/We authorize the landlord to verify my credit record, employment, residences and other income references. I/We certify that I have
paid my mortgage/rent payment, have not broken a lease, and have not filed for bankruptcy within the past five (5) years. I/We
understand that the discovery of false information or negative credit or financial information will result in denial.
A non-refundable charge of $
will be retained for credit check purposes,
I/We authorize Lessor and/or SafeRent to verify the accuracy of all statements in this application. I/We authorize all employers,
landlords and creditors to release all information concerning the applicant for purposes of verifying this applicant’s ability to afford
the contractual obligations of this lease.
Applicant Signature:
Date:
Applicant Signature:
Date:
Resident Representative Signature:
Date:
Michigan Rental Application Form
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