Nebraska Rental Application

NEBRASKA RENTAL
APPLICATION
Notice: Co-Signer must complete a separate Co-Signer
Application Form
Application
Fee
$
/each
Security
Deposit
$
Monthly
Rent
$
The undersigned hereby makes application to rent
at:
beginning
on
/
/
at
a
monthly
rental
rate
of
$
PLEASE TELL US ABOUT
YOURSELF
Agent:
FULL
NAME
Hm
Ph:
Date of
Birth
/
/
Social
Security
No. -
-
Cell
Ph:
Driver's
Lic. No. & State E-mail
Address
Other Occupants: Name Name
Name
Age 19 or
over?
Age 19 or
over?
Age 19 or
over?
Relationship
Relationship
Relationship
Any
Pets?
If so, what type and how
many?
PLEASE GIVE YOUR RESIDENCE HISTORY FOR THE PAST 3 YEARS
(Beginning
With Most
Current)
Current
Address
City
State
Zip
Month & Year Moved
In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
Previous Address
City State
Zip
(If within 3
years)
Month & Year Moved
In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
Previous Address
City State
Zip
(If within 3
years)
Month & Year Moved
In
/
Monthly Rent: $
Reson for Leaving:
Landlord
Phone:
Fax:
PLEASE GIVE YOUR EMPLOYMENT
INFORMATION
YOUR STATUS:
Self Employed Employed Full-Time Employed Part-Time Student Retired Not
Employed
***If you are self
employed
, you must
provide
a copy of your most
recent
tax
return
for
proof
of
income.
CURRENT EMPLOYER (or Most
Recent)
Address
Phone
(
)
Date(s) Employed / From to Fax (
)
Supervisor
Gross
Monthly
Salary
Position
PREVIOUS
EMPLOYER
Address
Phone
(
)
Date(s)
Employed
/
From
to
Position
If there are other sources of income you would like us to consider, please list income, source and person (Banker, Employer, etc.) who we could
call
for confirmation. You do NOT have to reveal alimony, child support or spouse's annual income unless you want us to consider it in this
application.
Amount
$
Per
Source
Telephone
HAVE YOU
EVER:
Been evicted or asked to move
out?
Yes
No
Been sued for non-payment of rent?
Yes
No
Broken a rental agreement or lease?
Yes
No
Been sued for damage to rental property?
Yes No Declared
bankruptcy?
Yes
No
Been convicted of a
felony?
Yes
No
If
so
please
explain
CONTINUED
OVER
Page 1/2
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Nebraska Rental Application PDF

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