TENANT INFORMATION First Name Middle Initial Last Name Social Security Number Current Address (Street, City, State, Zip Code) Time Spent at Current Address Date of Birth Primary Phone Number Email Address Driver's License Number Vehicle Information (Make, Model, Year, License Plate) Are you or any member of your family a smoker? YesNo List the names of everyone who will live in the residence List all pets by their type EMPLOYMENT INFORMATION Applicant's Employment Status Full TimePart TimeStudentUnemployed Employer Address (Street, City, State, Zip Code) Job Title Dates Employed Supervisor Name Phone Monthly Gross Pay If you would like us to consider other sources of income for this Rental Application, please list the amount and the person we may contact for confirmation. Please do not reveal alimony, child support, or anyone else’s income unless you want us to consider it in this Rental Application. Additional Amount Contact's Full Name and Phone Number RESIDENTIAL HISTORY: 2 YEARS Current Address (Street, City, State, Zip Code) Move-In Date Rent Owner/Agent Phone Reason for Leaving Previous Address (Street, City, State, Zip Code) Move-In Date Move-Out Date Rent Owner/Agent Phone Reason for Leaving CREDIT HISTORY Have you ever filed bankruptcy? YesNo Have you ever been evicted from a rental residence? YesNo Have you ever had a court order eviction? YesNo Are you a party to any lawsuits? YesNo Have you had any late rental payments in the last year? YesNo Are there any judgments against you? YesNo In the last five years, have you been convicted of any crimes? YesNo Have you ever filed bankruptcy? YesNo If you answered yes to any of the above questions, please explain REFERENCES Full Name Phone Full Name Phone REFERRAL INFORMATION How did you hear about this property? (Check One) CraigslistDirigo WebsiteZillowTruliaSignCurrent/Former ResidentOther A non-refundable application fee of $30.00 per applicant payable to Dirigo Management must accompany this application. I recognize that as part of your procedure for processing my rental application, an investigative consumer credit report and a criminal report may be prepared whereby information is obtained through current and/or previous Landlords. By my signature below, I represent that all of the information that I have disclosed in this Rental Application is true, accurate, and complete. I acknowledge that all of the information I have disclosed is material and Landlord is relying on the information to decide whether to grant or deny this Application. I authorize Dirigo Management Company to order and review my credit and criminal history and investigate the accuracy of all information contained in this Rental Application. I further authorize all banks, employers, and creditors to provide Dirigo Management Company any and all information concerning my credit. Applicant Full Name Date Co-Applicant Full Name Date Please note, we require a $30.00 non-refundable application fee to process your rental application. We only accept this fee via check payable to DMC and/or cash transaction at our office in One City Center, Portland Maine. I consent to a $30.00 non-refundable charge.
