Residential Rental Application

Personal Information

First name

Last name

Date of Birth

Month

Day

Year

Housing History

Current Address

Length of Time at Current Address (months/years)

Landlord Name/Phone Number

List any additional occupants (adult/minor) that will be living with you

Previous Address

Length of Time at Previous Address (months/years)

Previous Landlord Name/Phone Number

Employment & Financials

Current Employer

Position/Annual Income

Supervisor Name/Phone Number

Any Additional Sources of Income (Description/Annual Amount)

Please upload copies of your two most recent paystubs

Disclosures

Have you ever been Evicted

Have you ever filed for bankruptcy

Have you been convicted of a felony

Legal Authorization

I authorized the landlord/agent to obtain a consumer credit report and conduct a criminal background check as permitted by the Fair Credit Reporting Act and Wisconsin State Law. I understand I have the right to request a copy of these reports

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Building our Future

Honoring our Past

Residential Rental Application

Visit us on Facebook

Belgium Village Hall

Business Hours