Rental Application

Section 1:Applicant Information

Applicant’s Name (First, Middle,Last)

Applicant’s Mailing Address

Date of Birth

Social Security Number

Marital Status

Primary Email

Primary Phone #

Secondary Phone #

Previous Address

Section 1b: Co-Applicant Information

Co-Applicant’s Name (First, Middle,Last)

Date of Birth

Social Security Number

Marital Status

Primary Email

Primary Phone #

Secondary Phone #

Section 2: Coverages /Limits of Liability

Dwelling Limit

Other Structures Limit

Content Coverage Limit

Personal Liability EA OCC Limit

Medical Payments EA PER Limit

**Minimum personal property coverage $10,000 (includes furniture, clothing, electronics, etc

Pets

Yes No

**if yes specify type and breed

The undersigned hereby authorizes PL Realty and its affiliates, or third-party vendors to use the information obtained for the purposes of criminal background check, renter’s insurance, and credit history.