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Seckel Enterprises

 
 

RESIDENTIAL RENTAL APPLICATION
 
 
Landlord:   Seckel Enterprises, LLC        
Address of Rental Property*:          
Desired date of occupancy*:     Desired length of occupancy (in days)*:  
 
 
 
Name*:     Date of Birth:  
Social Security No*:     Driver's License No:  
 
 
rental
 
Present Address:  
How long at present address:   Home Phone No.:  
Current rent payment:     Reason for moving:  
Landlord's Name:     Phone No.:  
 
 
 
Prior Address:  
How long at prior address:  
Current rent payment:     Reason for moving:  
Landlord's Name:     Phone No.:  
 
 
 
Name of Spouse:   Date of Birth:  
Social Security No:     Driver's License No.:  
 
 
 
Water bed:   Yes No Smokers:   Yes No  
 
 
 
Do you own real estate?    Yes No              
 
If yes, please explain where:                
 
 
 
Have you ever been evicted from any rental premises?   Yes No                
If yes, please explain where:                 
 
 
 
Have you ever willfully and intentionally refused to pay rent when due?   Yes No      
If yes, please explain where:      
 
 
 
Have you ever been convicted of a felony?    Yes No              
 
If yes, please explain where:                 
 
 
 
Employer:   Business Phone no.:  
Position:   How long:  
Supervisor:   Annual Income:  
Other Income sources:   Child support/Alimony: Other:  
 
 
 
Employer:   Business Phone no.:  
Position:   How long:  
Supervisor:   Annual Income:  
Other Income sources:   Child support/Alimony: Other:  
 
 
 
Name:        
Address:          
Relationship:   Home Phone No.:  
 
 
 
Name:   Name:  
Address:     Address:  
Phone No.:     Phone No.:  
Relationship:   Relationship:  
 
 

Landlord does not discriminate against any applicant on the basis of an illegal purpose including, race, color, religion, sex, national origin, age, disability or family status. Such discrimination as the sole basis of refusal to rent is illegal throughout the United States. Local or State laws may provide additional protected classes from discrimination. You can call the U.S. Department of Housing and Urban Development (HUD) at 1-800-424-8590 to ask questions about discrimination. I represent that the information provided in this Application is true and correct to the best of my knowledge. I understand that this Application is not a rental agreement and that this Application does not create any obligation on the Landlord. I understand that the information provided might be used by Landlord to determine whether to accept this Application. I authorize Landlord to verify all the information given in this application, including banking and personal references and employment information provided.

 
Signature  

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