Rental Application

To apply as a tenant of one of our rental properties, you can conveniently and quickly fill out the form below or click here to download a PDF version of our application to fill out and either mail, fax at (573)-468-2386 or bring by our office. See our contact page for address and more contact information.
Applicant: SSN#: Date of Birth:
Cell Number: Home Number:
Co-Applicant Name: SSN#: Date of Birth:
Children, Name(s) and Ages: Cell Number:

Current Address: Current Rent Amount:
Current Landlord's Name: Phone: How Many Years?
Previous Landlord's Name: Phone: How Many Years?

How Many Pets (Breed): Dogs: Cats:
Other: Does anyone in your house smoke?

Current Employment Situation

Applicant's Employer: Date Employed: Monthly Income:
Address: Supervisor, Name and Number:
Co-Applicant's Employer: Date Employed: Monthly Income:
Address: Supervisor, Name and Number:

Previous Employment Situation

Applicant's Previous Employer: Date Employed: Monthly Income:
Address: Supervisor, Name and Number:
Co-Applicant's Previous Employer: Date Employed: Monthly Income:
Address: Supervisor, Name and Number:

Vehicle Information

Make/Model and License #:
Make/Model and License #:

Other Information

Have you rented from us before? If yes when/where:
Have you been evicted or foreclosed? If yes when/where:
Have you paid rent late? Do you have credit problems?
Have you been convicted of a felony? Have you had any drug related convinctions?
List State and Offense Conviction:
Do you have a checking account? Do you have a savings account?

Additional Contacts (Personal References)

Name: Phone: Relationship:
Name: Phone: Relationship:
Human Verification
(Please enter text from graphic):
BY SUBMITTING THIS INFORMATION, I AUTHORIZE THE PROPERTY MANAGER AT COLDWELL BANKER REEVES TO: check my credit history, obtain information from my current and previous employer, contact my current and previous landlord and to check references. I certify I am 18 years or older. I certify all information given is true and accurate to the best of my knowledge.

   Checked by the Applicant    Checked by the Co-Applicant

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