Rental Application

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Rental Application - Step 1 of 6

Renter Information

Lessee Name *

First

Last

Property Address *

Address Line 1

Address Line 2

City

State

Zip Code

Rental property address you are applying to.

Best phone number to reach you *

Email *

Name *

Date of Birth *

Please tell us your birthdate.

Marital Status *

Married
Single

Are you a US Citizen? *

Social Security Number *

Driver's Licence Number *

State *

The state in which your driver's license is registered.

Other Occupants

Will any other occupants be living at the residence? *

If yes, please list their names and relationship to you.

Name

Relationship to you

Age (if under 18)

Name

Relationship to you

Age (if under 18)

Name

Relationship to you

Age (if under 18)

Emergency Contact

Name *

Address

Phone

Pet Information

Will a pet or assistive animal of any type live on the property? *

Pet Type

Weight in lbs. (full grown)

Spayed/Neutered

Breed(s)

Licensed/Date

Current Address Information

Rent or Own *

Rent
Own

Curent Address

Address Line 1

Address Line 2

City

State

Zip Code

Monthly Cost *

How long have you lived there? *

Landlord Name *

Reason for leaving. *

Landlord Phone Number

Can we contact this landloard as a reference?

Former Address Information

Rent or Own

Rent
Own

Former Address

Address Line 1

Address Line 2

City

State

Zip Code

this Curent reference?

Monthly Cost

How long have you lived there?

Landlord Name

Reason for leaving.

Landlord Phone Number

Can we contact this landloard as a reference?

Employment Information

Current Place of Employment *

Position Held *

Supervisor *

Employer Phone *

How long were you employed here? *

Your Monthly Net Pay *

Other Source of Income for Rental Payment

Former Employment

Former Place of Employment

Position Held

Supervisor

Employer Phone

How long were you employed here?

Your Monthly Net Pay

Legal History

Have you ever filed Bankruptcy? *

When was your bankruptcy?

Under what chapters?

Have you ever been evicted? *

Eviction Date?

Have you ever been charged or convicted of a felony or any crime related to harm caused to a person or property, including but not limited to arson, assault, intimidation, sex crimes, drug-related offenses, theft, dishonesty, prostitution, obscenity, vandalism, and related violations? *

Do you use illegal drugs? *

Do you engage in the distribution or sale of illegal drugs? *

Do you have any outstanding warrants for arrest? *

Vehicle Information

Make *

Model *

Year *

License Plate # *

Lienholder

Balance Owed

Monthly Payment

Make

Model

Year

License Plate # *

Lienholder

Balance Owed

Monthly Payment

Make

Model

Year

License Plate # *

Lienholder

Balance Owed

Monthly Payment

Description of any other vehicle (boat, trailer, truck, recreational vehicle, etc.) you intend to keep on the property.

Do you intend to park any commercial vehicles on the property? *

If yes, please describe.

When do you plan to move in? *

How long do you anticipate staying? *

Rental Disclaimer

Management is not responsible for damage to residents' property unless it is caused by the negligence of management or an employee acting on behalf of management. We strongly advise obtaining renters' insurance to cover loss or damage to their personal property, which is not covered under the Landlord's Homeowner's Policy or any policy maintained by The Realty Agency, LLC.

Application Fee Notice

A non-refundable Application Fee of $30 will be charged to process this Application, whether or not you are provided a lease agreement.

Authorized Signature *

Clear Signature

Rental Application Fee *

Price: $30.00

This is a non-refundable rental application fee to process and review your application.

PayPal Checkout Payment *

Card Number

Expiration Date

Security Code

Card Holder Name

Pay for your rental application form quickly and securely.

We’re Here to Help You!

Have questions about renting? Let us walk you through the process and make it simple and stress-free.

Helpful Links

Available Properties

Meet the Team

Contat Us

2052 S. 4th Ave Yuma, AZ 85364

928-376-7000

Robert@YumaRentalHomes.com

Please enable JavaScript in your browser to complete this form.

Rental Application - Step 1 of 6

Renter Information

Lessee Name *

Property Address *

Address Line 1

Address Line 2

City

State

Zip Code

Rental property address you are applying to.

Best phone number to reach you *

Email *

Name *

Date of Birth *

Please tell us your birthdate.

Marital Status *

Married
Single

Are you a US Citizen? *

Social Security Number *

Driver's Licence Number *

State *

The state in which your driver's license is registered.

Other Occupants

Will any other occupants be living at the residence? *

If yes, please list their names and relationship to you.

Name

Relationship to you

Age (if under 18)

Name

Relationship to you

Age (if under 18)

Name

Relationship to you

Age (if under 18)

Emergency Contact

Name *

Address

Phone

Pet Information

Will a pet or assistive animal of any type live on the property? *

Pet Type

Weight in lbs. (full grown)

Spayed/Neutered

Breed(s)

Licensed/Date

Current Address Information

Rent or Own *

Rent
Own

Curent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Monthly Cost *

Landlord Name *

Landlord Phone Number

How long have you lived there? *

Reason for leaving. *

Can we contact this landloard as a reference?

Former Address Information

Rent or Own

Rent
Own

Former Address

Address Line 1

Address Line 2

City

State

Zip Code

Monthly Cost

Landlord Name

Landlord Phone Number

How long have you lived there?

Reason for leaving.

Can we contact this landloard as a reference?

Employment Information

Current Place of Employment *

Supervisor *

How long were you employed here? *

Position Held *

Employer Phone *

Your Monthly Net Pay *

Other Source of Income for Rental Payment

Former Employment

Former Place of Employment

Supervisor

How long were you employed here?

Position Held

Employer Phone

Your Monthly Net Pay

Legal History

Have you ever filed Bankruptcy? *

Have you ever been evicted? *

When was your bankruptcy?

Eviction Date?

Under what chapters?

Do you use illegal drugs? *

Do you engage in the distribution or sale of illegal drugs? *

Do you have any outstanding warrants for arrest? *

Vehicle Information

Make *

Model *

Year *

License Plate # *

Please type in your License plate number.

Lienholder

Balance Owed

Monthly Payment

Second Vehicle Information

Make

Model

Year

Vehicle 2 License Plate # *

Please type in your License plate number.

Lienholder

Balance Owed

Monthly Payment

Third Vehicle Information

Make

Model

Year

Vehicle 3 License Plate #

Please type in your License plate number.

Lienholder

Balance Owed

Monthly Payment

Do you intend to park any commercial vehicles on the property? *

Description of any other vehicle (boat, trailer, truck, recreational vehicle, etc.) you intend to keep on the property.

If yes, please describe.

When do you plan to move in? *

How long do you anticipate staying? *

Best Monthly Info

Rental Disclaimer

Application Fee Notice

A non-refundable Application Fee of $30 will be charged to process this Application, whether or not you are provided a lease agreement.

Authorized Signature *

Clear Signature

Rental Application Fee *

Price: $30.00

This is a non-refundable rental application fee to process and review your application.

PayPal Checkout Payment *

Card Number

Expiration Date

Security Code

Card Holder Name

Pay for your rental application form quickly and securely.

Rental Application

Renter Information

Other Occupants

Emergency Contact

Pet Information

Current Address Information

Former Address Information

Employment Information

Former Employment

Legal History

Vehicle Information

Rental Disclaimer

Application Fee Notice

Renter Information

Other Occupants

Emergency Contact

Pet Information

Current Address Information

Former Address Information

Employment Information

Former Employment

Legal History

Vehicle Information

Second Vehicle Information

Third Vehicle Information

Rental Disclaimer

Application Fee Notice

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