Rental Application You can fill out the application below, or click here to download the application and print. APPLICATION TO RENT AND RENTAL DEPOSIT – PATRICK HART, REALTOR Address you are Applying for: Full Name DOB (Date of Birth) Current Address Primary Phone Cell Phone Email Social Security # Drivers License/ ID # Employer Employer's Phone Position Length at Employer? Monthly Income Other Income Vehicles Owned Year/Model: Previous Employment if Less than 2 Years Have You File Either: Bankruptcy or Eviction? Yes No If Yes, Date? If Yes, Explain: Current Landlord Landlord Phone Years Here Past addresses/managers with phone numbers/time period: Names of all occupants to live in rental: Pets (# and type) Smoker? Yes No Note you MUST have approval for all pets. Smoking inside unit is not allowed. Emergency Contact Relationship Phone Address Cosigner? Yes No Current Bank? Current Balance Applicant represents the above information is true and complete and hereby authorize verification of the information provided, including obtaining a credit report, criminal check and rental history at the charge of $25 per applicant with an actual cost to Broker of $20. You may receive a copy of your report by paying an additional $10 Yes No By signing below, once approved and you leave security deposit, a per diem charge equal to rent will be deducted from deposit if you change your mind and not rent Date Time Preferred Phone to Contact Applicant Electronic Signature (your IP Address is captured when you submit this form.) You need the following w/application: 1) Paycheck Stub or Schedule C for Self Employ. 2) Copy of Drivers/Id Card. 3) Most recent checking statement. 4) $25 per applicant. Money order or Cash Okay for application fee. Office open to 5:30 most days. Patrick Hart Realtor, Inc. – 562.943-3249 - Cell 562.500-3249 – Fax 562.943-5781 Take application to Berkshire Hathaway – 16218 E. Whittier Blvd., Whittier 90603 Cross Street is First Ave. – East of the Whittwood Shopping Center Send
