Applicant Information:

First name:        Middle:                       Last name:                                    Maiden name:               

Driver's License # & State issued:                                                             Social Security #:

Date of birth                                                                                                 Email address:

Home Phone:                                      Cell Phone:                                    Alternate Phone:

Others living in the home (including minors):

1.  Full name/DOB/SSN 

2. Full name/DOB/SSN  

3. Full name/DOB/SSN

Employment & Income- Gross monthly income should be approx. 3 times the monthly rent

​Current Employment:                                Address:                  Manager name/phone

​Hire date:                       Hours per week:                          Gross wages                       Job title:

Other income sources:

Current & previous residences:

1.  Current address:                                                          Manager name/phone

​    Rent:  $                             Move in date:                    Why are you moving?    

2. Previous address:                                                        Manager name/phone

    Rent: $                                Move out date

Household Information:

​Adults      ______            We require a completed rental app for all persons over 18                       

Children​  ______            There is an occupancy limit of 2 people per bedroom    

Animals   ______            All animals require a pet application including service animals

Background Check:  

​Processing fee is $35 per adult over 18. Includes credit, criminal & residential history

Have you or any other applicant been abusers of controlled substances?

Have you or any other applicant been arrested or convicted of misdemeanors or felonies, including possession, distribution, or manufacture of controlled substances?

Are you or any other applicant a convicted sex offender?

​Have you or any other applicant broken a lease?           Please explain:

​Have you ever filed bankruptcy?                                       Date:

Emergency Contacts:  

In the event that we cannot contact you during an emergency, including non-payment of rent

1. Full name, address, phone 

​2.Full name, address, phone

Legal Release

Applicant authorizes Heartland River, Inc. and Awesome Rental Homes, their Managers, Employees and Agents to make any and all inquiries necessary to verify the information provided herein.  The Applicant represents that the application has been presented in full and all information is accurate and true to the best of their knowledge.  If the application if incomplete or if any such information is not as represented, then the Applicant may be disqualified.

This property requires a Deposit equal to one month's rent that must be paid in full once the Applicant is approved and before keys to the property are given.

 *Applicant, once approved must obtain Renter's Insurance.

​Applicant Signature and Date    

​​​​​​

 Date:                address applying for:                              Monthly rent:                     Your last name:

Ron 319-209-0823

​Heartland River

Awesome Rentals

1001 Oak Street

​Burlington, Iowa  52601

Ben 319-209-0827

​Rental Application/Agreement

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