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RENTAL APPLICATION
Equal Housing Opportunity

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Coulee Development, Inc

Owner/Operator

N15526 Delaney Rd. Trempealeau, WI. 54661

Phone: 608-539-2050 Fax: 608-539-2064

Toll Free: 1-877-288-9234

 

 

I,  hereby make this application to rent the following property: 

                              (Name)

 (Check appropriate items):

House Rental - 12132 King St., Trempealeau, WI. 54661

3-Bedroom @ $1,000 per mo.

   

   
 

Anticipated move date of

Enter total Rent Cost $

Enter Deposit (Equal to First Months Rent) of $.

 

PLEASE TELL US ABOUT YOURSELF

Full Name Home/Cell Phone    .
Date of Birth (Applicant must be at least 18 years of age to contract for a lease)  Social Security # .
Email Address: (optional)    Other Phone
Co-Applicant Name Co-Applicant Date of Birth  SSN #
Dependents Name & Date of Birth
List Type & Name of All Pets (See Pet Addendum, add. Costs Apply)

PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)

Current Address Apt# City State Zip
Month/Year Moved In Reasons for Leaving Rent $
Owner/Agent Phone
Previous Address (last 3 years) Rent $
Apt# City State Zip
Month/Year Moved In Reasons for Leaving Rent $

Owner/Agent Phone
 

PLEASE DESCRIBE YOUR CREDIT HISTORY

 

     Have you ever been convicted of or pleaded guilty or "no contest" to a misdemeanor involving sexual misconduct?      Yes    No
       Have You Ever been convicted of or pleaded guilty or "no contest" to a felony?      Yes    No

Have you declared bankruptcy in the past seven (7) years?

Yes    No

Have you ever been evicted from a rental residence?

Yes    No

Have you had two or more late rental payments in the past year?

Yes    No

Have you ever willfully or intentionally refused to pay rent when due?

Yes    No

 

PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION

Your Employment Status:  Full Time Part Time Student Unemployed
Employer/School You Attend:
Dates employed/In School Employed as
Supervisor Name/School Administrator    Phone
Salary $ per month. 

If employed by above less than 12 months, give name & phone of previous employer or school: .
 

If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

Amount $ Source/Contact Name

 

Credit: A complete check of credit history will be made. Applicant must have a favorable credit rating. No charged off accounts, collections, judgements, or   bankruptcies within the past five years will be accepted.

Income: A prospective resident must meet the minimum income requirements:
1 Occupant: Must have gross monthly income of at least 3 times monthly rent.
2 Occupants: Must have combined gross monthly income of at least 3.5 times the monthly rent.
3 Occupants: Must have combined gross monthly income of at least 4 times the monthly rent.


 

PLEASE LIST YOUR REFERENCES


Personal Reference or Emergency Contact:
Name Address
Phone Relationship

Driver's License:
Your Driver's License Number State
Vehicle (s) Information:
Make / Model Year License Plate State

Make / Model Year License Plate State

 

** The Applicant must have a positive past rental reference or have previously owned a home (with mortgage in good standing). This includes no late rent payments, Unlawful Detainers, or lease violations.

 

ADDITIONAL INFORMATION:

Please give any additional information that might help owner/management evaluate this application?

Where may we reach you to discuss this application?

Day Phone #         Night Phone #
 

  • Application Process

    - Submission of this application does not serve as a reservation of the apartment you are applying for.
    - The application fee is non-refundable and must be paid before any verification begins.
    - All information provided on the application must be complete and correct or we will be unable to process your application.
    - Inability to verify any portion or finding discrepancies is basis for rejection.
    - If the application is accepted, you will be notified by telephone to set up a lease signing.
    - If the application is denied, you will receive a denial letter..
     

  • Other Policies

    - For your convenience, all incoming residents must participate in the ACH program. This program allows for your monthly rent payment to be deducted from your checking, savings or other applicable account (detailed information about this program is available at your lease signing or by request).
    - All of our residents are required to provide a copy of their driver's license or state ID and their most recent pay-stub (or previous year's tax return) at the time of lease signing for their file.
    - Pets: cats, fish, and some other small pets may be allowed in the apartment. A monthly pet fee and signed agreement with management's approval are required to keep pets in any apartment
    - Coulee Development, Inc. does not discriminate against tenants or prospective tenants based on race, color, creed, religion, national origin, sex, marital status, disability, sexual orientation, or age. These policies comply with the Equal Housing Opportunity Act and other similar laws.

     

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application, I warrant that all statements above set forth are true.

 

I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

The above information, to the best of my knowledge, is true and correct.

Please sign:  X                  
                                   Name of Applicant                                                    Date

AUTHORIZATION
Release of Information

I authorize the release of income and employment history from my current and previous employers as well as rental history from my current and previous landlords. This release is valid for 1 year, unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one year, or as allowed by law.
Name (please print)

X                         
                  Signature                                                                              Date

Be sure to Print this page for your records.

APPLICANT:  PLEASE DO NOT WRITE BELOW  (FOR OFFICE USE ONLY)

Received by ____________________________ Date_______________

OFFICE NOTES:

                                           

 

 

 

                                                  

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Coulee Development Inc.,N15526 Delaney Rd
Trempealeau, WI 54661
Toll Free 877-2BUY-CDI
(1-877-228-9234)

Fax: 608-539-2050

sales@couleedevelopment.com

 

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