E-mail us on the contact page for credit application.
Rental Credit Application
Note: A non-refundable $30.00 application fee is required before processing this application.
Please complete all requested information on this form.

APPLICANT'S NAME:____________________________________________________________________________________________

SSN#_____________________________DATE OF BIRTH____________________MARITIAL STATUS___________________________

DRIVER'S LIC. # & STATE ___________________________________________     ________________

HOME PHONE____________________________________________________CELL PHONE__________________________________

CO-APPLICANTS NAME: _________________________________________________________________________________________

SSN#____________________________DATE OF BIRTH_____________________MARITIAL STATUS___________________________

DRIVER'S LIC.# & STATE ____________________________________________  __________________

HOME PHONE____________________________________________________CELL PHONE___________________________________

PRESENT ADDRESS_____________________________________________________________________________________________

HOW LONG____________________________________

PRESENT LANDLORD___________________________________________PHONE#_________________________________________

EMPLOYMENT REFERENCES:

EMPLOYER / ORGANIZATION______________________________________________________________________________________

ADDRESS____________________________________________________PHONE____________________________________________

POSITION______________________________________________HOW LONG?_____________________SALARY__________________

PREVIOUS EMPLOYER____________________________________________________________________________________________

ADDRESS___________________________________________________PHONE______________________________________________

POSITION_____________________________________________HOW LONG?______________________SALARY___________________

CO APPLICANT EMPLOYEE REFERENCES

EMPLOYER / ORGANIZATION_______________________________________________________________________________________

ADDRESS___________________________________________________PHONE______________________________________________

POSITION___________________________________________________SALARY______________________________________________

NAME / ADDRESS / PHONE# OF BANK

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

CREDIT CARD INFORMATION / NAME / TYPE

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

I hereby make application for a rental and certify that this information is correct. I authorize Simmons Rentals to contact any references that I have listed and to run a credit report. If applicant is approved and the propertyis taken off the market, the security / damage deposit will be forfeighted should the applicant not lease the property.

APPLICANT'S SIGNATURE_________________________________________________________________________DATE______________

CO-APPLICANT'S SIGNATURE______________________________________________________________________DATE______________

LIST ALL PERSONS TO OCCUPY PROPERTY:________________________________________________________AGE________________

_______________________________________________________________________________________________AGE________________

_______________________________________________________________________________________________AGE________________



Please fill out in full and sign.