20 2nd St, Havre, MT 59501

RENTAL APPLICATION

We have a number of rental properities that may be available. If you are seeking a rental property, please fill out the application below.

Date of Application

Type and size of apartment desired

Price range desired

Desired date of occupancy

Do any of the following apply?

Have a waterbed

Have a piano/organ

Smoke

None of the above apply

Do you have a pet?

Yes

If you have a pet, please list type of pet.

PERSONAL INFORMATION

Applicant's full name

Have you been know by other names? If so, please indicate.

Date of Birth

Month

Day

Year

Phone Number

Social Security Number

List names of persons other than the applicant who will be residing in the unit.

Have you or any member of your household ever been convicted of or plead guilty or "no contest" to a felony?

Yes

Have you or any member of your household ever been convicted of or plead guilty or "no contest"to a misdemeanor involving sexual misconduct?

Yes

If yes, please describe.

Are you required to register as a sexual or violent offender?

Yes

RESIDENCE HISTORY

We require two (2) rental referances or two (2) full years of rental history, whichever is greater. Please list your actual landlord or property manager, NOT ROOMATES.

Present address

Dates resided

Amount of rent

Present landord

Phone Number

Reason for leaving

Previous address

Dates resided

Amount of rent

Previous landord

Phone Number

Reason for leaving

Please account for any gaps in rental history.

Is there any reason you cannot have the utilities turned on in your name?

Yes

If yes, please explain.

PERSONAL REFERENCES

Personal relatives cannot be a relative.

Reference 1 Name

Reference 1 Address

How long have you known them?

Phone Number

Reference 2 Name

Reference 2 Address

How long have you known them?

Phone Number

Reference 3 Name

Reference 3 Address

How long have you known them?

Phone Number

INCOME INFORMATION

List all verifiable sources of income you wish to have considered in the evaluation of this application.

Income Source 1

Monthly Income

Verification Phone Number

Income Source 2

Monthly Income

Verification Phone Number

Income Source 3

Monthly Income

Verification Phone Number

AUTOMOBILES

Auto 1: List make/model, year, state/license#

Auto 2: List make/model, year, state/license#

EMERGENCY CONTACT INFORMATION

Emergency Contact Name 1

Emergency Contact Address

Emergency Contact Phone Number

Emergency Contact Relationship

Emergency Contact Name 2

Emergency Contact Address

Emergency Contact Phone Number

Emergency Contact Relationship

I expect to reside on the premises

6 months or less

1 year

2 years or more

__________________________

With my signature, I agree the statements above are true and correct. I hereby verify that I am 18 years or older, or otherwise competent to enter into a binding rental contract and I understand that I will be fully responsible for the terms of the rental contract.

I hereby authorize the landlord, agents or staff to contact any persons, corporations, employers, agencies, offices, groups or organizations to obtain any information, credit report or material which is deemed necessary to verify the information and statements in the application.

In the event the application is approved and I desire to rent the premises, I agree to fill out and sign the rental agreement and the condition of premises.

Signature

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Date