8/18/2019 Utah Rental Application
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Rental Application - Page 1 of 2
R ENTALAPPLICATION Provided
by www.utahevictionlaw.com
Please Return to Landlord/Manager:
____________________________________________
Phone: _______________________ Landlord/Manager Email:
_______________________________________________________
Fax: _______________________ Property address
applied for _____________________________________________________
Date needed _________________
1. Applicant's Info. Name_______________________________
Sex____ Birth Date______________ SS# ___________________Present
Address ________________________________ Apt # _______ City
__________________ State ______ Zip __________Home _______________
Cell ________________
Email____________________________________________________Driver's
License No.______________________ State______ Marital Status (check
one) Single _____ Married _____ Other _____If “Other”, please
explain
____________________________________________________________________________________
2. Rental History
Current Landlord ___________________________ Address
_____________________________ City ____________ State _____Phone
__________________ How long at this address? Years ____ &
Months ____ Rents: $_________ Were you ever late? ____Previous
Landlord __________________________ Address
_____________________________ City ____________ State _____Phone
__________________ How long at this address? Years ____ &
Months ____ Rents: $_________ Were you ever late? ____
3. Applicant Work History
Current Employer ___________________________ Address
_____________________________ City ____________ State _____Type of
Work ___________________________________________________________
Worked from ____/____ until ____/____Phone at Work
______________________ Monthly Net Income $ __________Previous
Employer __________________________ Address
_____________________________ City ____________ State _____
Type of Work
___________________________________________________________ Worked
from ____/____ until ____/____Phone at Work ______________________
Monthly Net Income $ __________
4. Co-Applicant's Info. Name_____________________________
Sex____ Birth Date_____________ SS# ___________________Present
Address ________________________________ Apt # _______ City
__________________ State ______ Zip __________Home _______________
Cell ________________
Email____________________________________________________Driver's
License No.______________________ State______ Marital Status (check
one) Single _____ Married _____ Other _____If “Other”, please
explain
____________________________________________________________________________________
5. Co-Applicant’s Work History
Current Employer ___________________________ Address
_____________________________ City ____________ State _____Type of
Work ___________________________________________________________
Worked from ____/____ until ____/____Phone at Work
______________________ Monthly Net Income $ __________Previous
Employer __________________________ Address
_____________________________ City ____________ State _____
Type of Work
___________________________________________________________ Worked
from ____/____ until ____/____Phone at Work ______________________
Monthly Net Income $ __________
6. Other Income $ ___________ per month in ____
Unemployment ____ Child Support ____ Alimony ____ SSI ____ AFDC
____Other
(explain):____________________________________________________________________________________________
7. Occupants. List name, age, and relationship of all
persons, other than yourself, that will be occupying the premises
(includingchildren, relatives, and other co-residents):
Name ________________ Age ____ Relationship _____________
Name ________________ Age ____ Relationship _____________ Name
________________ Age ____ Relationship _____________ Name
________________ Age ____ Relationship _____________ Name
________________ Age ____ Relationship _____________ Name
________________ Age ____ Relationship _____________
8. Vehicles List all vehicles to be parked on the
premises by applicant, spouse, children (including cars, trucks,
motorcycles, etc.):Make _________________ Model _______________
Year _______ Color ____________ License # ________________ State
_____Make _________________ Model _______________ Year _______
Color ____________ License # ________________ State _____
Make _________________ Model _______________ Year _______ Color
____________ License # ________________ State _____
9. Smoking Will anyone occupying the residence be
smoking? _____ If Yes, how many? _____ If yes, are you willing to
smokeoutside? _____ By initialing below, I agree to be responsible
for any smoking damage to the dwelling caused by me, my
familyinvitees, or guests. Damage shall include but not be limited
to replacing any burned flooring or counter tops, repainting
wallsand/or other costs, fines or charges as stated in the rental
agreement between myself and the Landlord. Initials: ____ /
____.
10. Pets Will anyone have a pet? _____ Kind
____________________ Weight _______ Breed ____________________ Age
_____By initialing below, I agree to be responsible for any pet
damage in the dwelling that occurs during my occupancy. Damage
shalinclude but not be limited to replacing all carpeting and pad
in the entire unit. Initials ____ / ____.
11.
Applicant & Co-Applicant Bank
Info Name__________________________ City_____________ Phone
___________________Checking Account No.
______________________________ Approx. Balance $ __________Savings
Account No. ______________________________ Approx. Balance $
__________
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8/18/2019 Utah Rental Application
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Rental Application - Page 2 of 2
12.
Current Debts (Everyone you make payments to)
Company (Creditor) Balance (Amount you owe) Monthly Payment
1.
2.
3.
4.
5.
13. Why are you (applicant and/or co-applicant) leaving
your current
residence? _________________________________________________________________________________________________________
14. Have you (applicant and/or co-applicant) ever been
evicted? _____ If Yes,
explain. _________________________________________________________________________________________________________
15.
Have you (applicant and/or co-applicant) ever broken a rental
agreement or lease contract? _____ If Yes,
explain. _________________________________________________________________________________________________________
16. Have you (applicant and/or co-applicant) ever been
given any eviction notice(s) or sued for non-payment of rent or
damages torental property? _____ If Yes, explain.
17.
Have you (applicant and/or co-applicant) ever been charged with
or convicted of a felony or any drug related offense?If Yes,
explain.
18.
Have you (applicant and/or co-applicant) ever filed bankruptcy?
________ If Yes, what month & year?Is it now discharged?
_______ When was (or when will) it be discharged?
_____________________________________________
19.
How did you find us? ____ Just stopped by, ____ Newspaper, ____
Vacancy Sign, ____ Friend (name) ______________________Real Estate
Agent ______________________, or ____ Other (please explain)
20. What features do you particularly like
here: _________________________________________________________________________________________________________
21.
Emergency Contacts Option #1 Name
__________________________ Phone ______________________
Relationship __________________________Address
___________________________________ Apt # ______ City
_______________ State ______ Zip ________Option #2 Name
__________________________ Phone ______________________
Relationship __________________________Address
___________________________________ Apt # ______ City
_______________ State ______ Zip ________
CORRECT INFORMATION – (You must sign to
complete application)
The Applicant represents all of the above statements to be true
and complete, and hereby authorizes verification to be made ofabove
information, references, credit history and criminal background.
The Applicant acknowledges that false information hereinconstitutes
a material breach of any rental agreement entered based on this
application and authorizes the Landlord to evict or
deny possession to the Applicant. False information provided
on this document may also constitute a criminal offense under the
laws of thestate of Utah and be cause for eviction, denial of
tenancy or prosecution.
At the time a security deposit is paid by the Applicant to the
Landlord or the Landlord’s representative to show the Applican
t'sintent to secure and/or hold a specific rental property, the
Applicant understands and agrees to the following: (1) the payment
andreceipt of the security deposit does not guarantee the approval
of any application or that the Applicant is guaranteed tenancy; (2)
if theLandlord's approval is not given, the security deposit will
be refunded to the Applicant, and (3) if the application is
approved by theLandlord or the Landlord's representative, any
security deposit paid becomes NON-REFUNDABLE if for any reason, at
the fault ofthe Applicant, the Applicant fails to execute the
landlord's Lease Agreement.
Applicant (Print) ____________________________________
(Sign) ____________________________________ Date
__________________________
Co-Applicant (Print) ____________________________________
(Sign) ____________________________________ Date
__________________________
Copyright © 2009-11. This form provided by the Law Offices of
Jeremy M. Shorts, LLC.
P.O. Box 971233, Orem, Utah 84097. Phone: 801-610-9879.
Email: [email protected].
Visit www.utahevictionlaw.com for more
landlord forms and materials.You can also join our mailing list
at www.utahevictionblog.com for other
landlord information.
Rev. 4-3-1
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