Rental Application

Rental Application Form

"*" indicates required fields

PLEASE READ THIS FIRST

Call our friendly staff and bring your completed application to your scheduled appointment along with $75.00 per person (18 or older) in the form of a cashier’s check or money order. Please call our office if you have any questions at (772) 267-2001.

First Name*

Middle Name*

Last Name*

Birthdate*

Social Security Number*

Email*

Phone 1*

Phone 2*

Driver's License #*

State*

Other Names Ever Used Incl. Maiden Name*

Additional Occupants*

Additional Adults & Children

Age

Relationship To Applicant

Current Address*

Street Address Address Line 2 City State ZIP Code

How Long At Current Address?*

Current Owner/Manager*

Current Owner/Manager Phone*

Last Month Rent Paid - Current*

Amount Paid - Current*

Reason For Leaving Current*

Previous Address*

Street Address Address Line 2 City State ZIP Code

How Long At Previous Address?*

Last Month Rent Paid - Previous*

Amount Paid - Previous*

Previous Owner/Manager*

Previous Owner/Manager Phone*

Reason For Leaving Previous*

Employment

Current Employer Name*

Current Position*

Current Employer Phone*

Current Employer Address*

Type of Business*

Dates Employed*

Monthly Salary*

Other Income*

Previous Employer Name*

Previous Position*

Previous Employer Phone*

Previous Employer Address*

Type of Business*

Dates Employed*

Monthly Salary*

Other Income*

References

Financial*

Please list all financial references for review.

Bank Name

Bank Address

Checking/Savings?

Balance

Credit Card/Car Payments*

Please list all credit card and car loan payments for review.

CC Name or Car Loan

Address

Monthly Payment

Balance

Personal References*

Please list all applicable personal references for review.

Name

Address/City

Relationship

Phone

Emergency Contact*

Please list any emergency contacts you have.

Name

Address/City

Relationship

Phone

Additional Information

Have you ever had credit problems?*

Yes

Have you ever had an unlawful detainer (eviction) filed against you?*

Yes

Have you ever been evicted for non-payment of rent or any other reason?*

Yes

Have you ever refused to pay rent for any reason?*

Yes

Have you ever filed bankruptcy?*

Yes

Has it been discharged?*

Yes

Do you or anyone in your household smoke any substance indoors?*

Yes

Have you ever been convicted for selling, possessing, manufacturing illegal drugs?*

Yes

Have you ever been convicted of a felony?*

Yes

Will you have or intend to have any pets?*

Yes

How many pets?*

Please enter a number less than or equal to 4.

Have you ever lived here before?*

Yes

Do you know anyone living here now or in the past?*

Yes

Please describe any "Yes" answers.*

How did you hear about us?

Automobiles

Automobile #1

Year*

Model*

Make*

Color*

License Plate*

State*

Automobile #2

Year*

Model*

Make*

Color*

License Plate*

State*

Applicant warrants that all information contained in this application is true and accurate. I authorize verification of the information contained herein for the purpose of establishing my qualifications as a tenant. I release anyone verifying such information or providing information from liability. I understand that incomplete or incorrect information provided in the application may cause a delay in processing and can result in denial of tenancy. I further authorize Gold Coast Residential to obtain a credit report and check criminal records. I further understand that any false information or misrepresentation can be a basis for terminating any tenancy that may result if this application is approved. This application will be incorporated into any lease agreement entered into pursuant to this application. I understand that Gold Coast Residential does not tolerate or condone illegal activity in or around the premises, including, but not limited to, activity related to narcotics use, possession, sales, manufacturing or distribution. I hereby apply to rent this house and upon approval of my application, agree to pay the first and last month’s rent and a security deposit. Gold Coast Residential charges $75.00 per person for the credit report and verification of information contained in the credit report and application. This $75.00 fee is non-refundable and must be in the form of a cashier's check or money order made payable to Gold Coast Residential. We do not discriminate based on race, ethnic background, national origin, religion, sex, marital status, age, familial status, disability, sexual orientation, receipt of public assistance, or personal characteristics or traits.

I hereby apply to rent a house*

House Address*

At a rate of*

And upon approval of my application, agree to pay the first and last month’s rent of*

And a security deposit in the amount of*

Please type your name*

Phone

This field is for validation purposes and should be left unchanged.