Capella Realty Group Rental Application

RESIDENTIAL RENTAL APPLICATION

Companv Information:
Property Manager/Agent for Owner:
Capella Realty Group, LLC
4901 Eastpark Blvd, Suite 200
Madison, WI 53718

Referred From:

Name:

Company:

Association:

Phone:

Untitled
Interested in renting?

Untitled
Interested in buying?

Untitled
Do you need a Realtor®?

Rental Property Information

Rental Property Address:

Term of tenancy:

Application to rent suite #:

Monthly Rent:

Requested Move in Date:

Security Deposit:

Applicant's Personal Information — Anyone over 18yr MUST submit a separate application.

Applicant’s Full Name:

Middle Name:

Last:

Home Phone:

Alternative Phone:

Email Address:

Date of Birth:
MM slash DD slash YYYY

Hidden

Applicant’s SSN:

2nd Applicant Adult

Full (first, middle, last):

Date of Birth:
MM slash DD slash YYYY

Hidden

Applicant’s SSN:

3rd Applicant Adult

Full (first, middle, last):

Date of Birth:
MM slash DD slash YYYY

Hidden

Applicant’s SSN:

Name(s) of Dependent(s)/Children:

Date(s) of Birth
MM slash DD slash YYYY

Name(s) of Dependent(s)/Children & Date(s) of Birth:

Do you anticipate anyone else moving in within the next 12 months?

Do you have a pet?

Yes

No

Do you plan to get one?

Yes

No

If more than one, how many?

Please describe:

Do you, or anyone in your household smoke?

Yes

No

Residential History: Please provide the last ten (10) years of residential history — if necessary, use additional page(s).

Present Address:

City:

State:

Zip Code:

Dates at this address?

Landlord/Lessor:

Phone:

Are you on the lease?

Fax:

Previous Address:

City:

State:

Zip Code:

Dates at this address?

Landlord/Lessor:

Phone:

Were you on the lease?

Fax:

Previous Address:

City:

State:

Zip Code:

Dates at this address?

Landlord/Lessor:

Phone:

Were you on the lease?

Fax:

Previous Address:

City:

State:

Zip Code:

Dates at this address?

Landlord/Lessor:

Phone:

Were you on the lease?

Fax:

Banking Information:

Banking Institution:

Address:

Phone:

Vehicle Information:

Make/Model:

Year!

License Plate:

Color:

Driver’s License Number:

Parking stall required?

Yes

No

Additional stall required? (Subject to availability)

Yes

No

References:

Name/Relationship:

Phone:

Name/Relationship:

Phone:

Emergency Contact:

Name/Relationship:

Phone:

Eviction History:

Any evictions and/or eviction filings in the last 10 years? (If yes, and you are accepted, this will increase the amount of security deposit you will need to have on file. Also, you will be on a month-to-month lease).

Yes

No

Date of eviction/eviction filing (please circle):
MM slash DD slash YYYY

Status:

Multiple evictions:

Criminal & Credit Background Check:

Any criminal activity in the past 10 years?

Yes

No

Date of eviction/eviction filing (please circle):
MM slash DD slash YYYY

Status:

Multiple convictions/charges:

Is there anything else negative that we may find in your background (behavioral, criminal, non-criminal, etc.)? Please explain below. Falsifying your application will lead to automatic denial.

Details of Employment:

Employer:

Location:

Position:

Date Hired:
MM slash DD slash YYYY

Last Day:

Supervisor:

Phone:

Wages:

Fax:

If employed less than two years with present employer, please provide previous employer).

Employer:

Location:

Position:

Date Hired:
MM slash DD slash YYYY

Last Day:

Supervisor:

Phone:

Wages:

Fax:

Employer:

Location:

Position:

Date Hired:
MM slash DD slash YYYY

Last Day:

Supervisor:

Phone:

Wages:

Fax:

You may provide copies of your last two pay stubs; if not employed, please provide award letter(s) no older than 6 months from application date.

Total amount of monthly assistance:

Gross monthly income per month:

Other Sources of Income: Please check all that apply and enter amount:

Pension Benefits $

Section 8 $

Social Security $

Alimony $

Child Support $

Other $

Please provide contact information for your payee or case worker(s):

AUTHORIZATION TO RELEASE INFORMATION FOR RESIDENTIAL RENTAL PURPOSES

I declare that the information I have provided is accurate. I authorize Capella Realty Group, LLC to whom this application is submitted to: (a) contact my references and all other persons that I have named in this application; and (b) perform a credit and/or criminal check to assess my suitability as a tenant/lessee. I also understand that any incomplete or false information I have provided is subject to automatic denial of the application.

Applicant’s Signature

Date
MM slash DD slash YYYY

Hidden

Social Security Number

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RESIDENTIAL RENTAL APPLICATION

AUTHORIZATION TO RELEASE INFORMATION FOR RESIDENTIAL RENTAL PURPOSES

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