Rental- application - Jerry's Houses

Rental Application

A word about the security of your personal information: Jerry's Houses uses industry standard encryption algorithms as specified by the Open PGP Standard to ensure the security, privacy and authenticity of your information. The information you enter into the form below is encrypted when you submit the application and is then transmitted to a secure, encrypted mailbox to await our retrieval. At no time is your personal information sent to or from our systems in an unencrypted state.

Rental Application Form

Which Jerry's Houses unit are you applying for?

Personal Information

Applicant Name:

Phone Number:

E-mail Address:

Date of Birth:

Drivers License #:

Social Security:

What year are you graduating?

Please tell us the name of your fraternity or sorority (or if you are a proud GDI!):

Address Information

Current Address:

Landlord Reference

Landlord Name:

Phone:

Vehicle Information

Make:

Model:

Year:

Emergency Contact

Contact Name:

Relationship:

Phone:

E-mail Address:

Other Information

How did you find out about Jerry's Houses?

If you were referred, who referred you? We would like to send them a Thank You!

The applicant hereby certifies that they are of legal age and the above information is true and accurate and is aware that the owner/manager of the property will rely on this information when entering into a rental agreement. The applicant recognizes that any falsification; misrepresentation or omission will result in the rejection of the application. The applicant authorizes Jerry's Houses to investigate all statements contained in this application including but not limited to employment and income verification, landlord references, to obtain a credit report, and to periodically update this information throughout the lease term or any extension thereof as allowed by law. Information provided in this Rental Application will be incorporated into and become part of the terms and conditions of the lease if a lease is executed.

Applicant Name:

Date: