Application to Rent

Name*

First Last

Email*

Date of Birth*

Social Security Number*

Driver's License Number

Driver's License State

Cell Phone

Home Phone

Work Phone

Present Address

Address

Street Address City State ZIP Code

Move In Date

Move Out Date

Owner/Manager Name

Phone

Reason for Leaving

Rent per month?

Do you have a previous address?

Yes
No

Previous Address

Address

Street Address City State ZIP Code

Move In Date

Move Out Date

Owner/Manager Name

Phone

Reason for Leaving

Rent per month?

Name and Age of Other Occupants

1st Person

Name

Age

Date of Birth

Relationship

ex: brother, father, son, daughter, etc.

Do you wish to add a 2nd person?

Yes
No

2nd Person

Name

Age

Date of Birth

Relationship

ex: brother, father, son, daughter, etc.

Do you wish to add a 3rd person?

Yes
No

3rd Person

Name

Age

Date of Birth

Relationship

ex: brother, father, son, daughter, etc.

Do you wish to add a 4rd person?

Yes
No

4th Person

Name

Age

Date of Birth

Relationship

ex: brother, father, son, daughter, etc.

Occupation

Present Occupation

Name of Employer

How long have you worked here?

Name of Supervisor

Phone Number

City

State

Current Gross Income

Pay Period

Prior Occupation

Name of Employer

How long did you work there?

Name of Supervisor

Phone Number

City

State

List Financial Obligations

Creditor Name

Monthly Payment

Creditor Name #2

Monthly Payment #2

In Case of Emergency

Contact Name

Phone Number

Relationship

Has anyone who will reside in the premises been arrested/convicted/accused of a crime against persons or property, or drug/alcohol related crimes?

Yes
No

Has anyone who will reside in the premises filed a petition in Bankruptcy?

Yes
No

Has anyone who will reside in the premises been on Parole/Probation?

Yes
No

Has anyone who will reside in the premises been evicted?

Yes
No

Does anyone who will reside in the premises smoke?

Yes
No

Does anyone who will reside in the premises have pets?

Yes
No

What kind of pets: ex. type of animal, breed and age?

Please include any additional information you wish to provide.

Applicant represents that all of the above statements are true and correct and hereby authorizes verification of the above items including but not limited to the obtaining of credit reports and agrees to furnish additional credit references on request. Applicant also attests that all occupants of the apartment will be legal to reside in the United States.

The undersigned makes application to rent housing accommodations designated as: Riviera West, 872 West 500 South, Salt Lake city, 84104. Upon approval of this application, applicant agrees to sign a rental or lease agreement and to pay all sums due, including deposits, before occupancy.

E-Signature*

By checking this box, you acknowledge the name below is your signature on this form:

Type Your Name Here to E-Sign Your Rental Application*

Application Fee (non-refundable)*

Price:

Important Note

In order to process your application, you must pay a $20 application fee. By click the Submit button below, you will be directed to PayPal in order to submit pay your application fee. If you do not complete payment, your application will not be processed

All applications will be reviewed in the order received and judged based on the owner’s rental criteria. Owner does not discriminate on the basis of race, color, religion, sex, national origin, disability, familial status or source of income.

CAPTCHA

Present Address

Previous Address

Name and Age of Other Occupants

Occupation

List Financial Obligations

In Case of Emergency

Riviera West Gallery

Our Location