Residential Rental Application
Each person over the age of 18 who will reside in the unit must complete a separate application.
Name
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First
Last
Middle Initial
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Maiden/Other Name(s)
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Date of Birth
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02
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day
/
January
February
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April
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December
month
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2020
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1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
year
SSN #
*
Phone
*
Text Message?
*
Yes
No
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo (Brazzaville)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wales
Yemen
Zambia
Zimbabwe
Country
How did you hear about Wellco, LLC?
*
Facebook
Instagram
TikTok
Twitter
YouTube
LinkedIn
Pinterest
Website
Google
Referral
Other
Email
*
Driver's License #
*
State
*
How many cars, boats, motorcycles, etc. will be kept on the premises?
*
Vehicle Description(s)
*
License Plate(s) #
*
Emergency Contact #1
*
First
Last
Emergency Contact #1 Phone
*
Emergency Contact #2
*
First
Last
Emergency Contact #2 Phone
*
Desired Location
*
Maximum Rent
*
Are you currently able to provide one month rent plus a security deposit (equal to one month rent)?
*
Select value
Yes
No
Desired Occupancy Date
*
Others Occupying Unit
*
Total Occupants Over 18
*
Co-Applicant Names:
*
Will any smokers occupy the unit?
*
Select value
Yes
No
Will any pets occupy the unit?
*
Select value
Yes
No
I acknowledge that smoking is not permitted inside the unit. I acknowledge that smoking inside the unit may result in additional fees upon leaving the unit.
*
Pets are not accepted in all locations. I acknowledge that should my pet be accepted, I will be charged a non-refundable pet fee and additional monthly pet rent.
*
What pets will occupy the unit?
*
Current Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Current Landlord
*
First
Last
Current Landlord Phone
*
Date Occupied
*
What is your reason for leaving?
*
Are you currently being evicted?
*
Select value
Yes
No
Current Rent
*
Do any pets occupy the unit?
*
Select value
Yes
No
Have you complied with all terms of your lease? If not, explain.
*
Have you ever been behind on your rent? If so, explain.
*
Have you received any complaints from the landlord?
*
Previous Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Previous Landlord
*
First
Last
Previous Landlord Phone
*
Previous Date Occupied
*
What was your reason for leaving?
*
Were you evicted from this address?
*
Select value
Yes
No
Previous Rent
*
Did any pets occupy the unit?
*
Select value
Yes
No
Did you comply with all terms of your lease? If not, explain.
*
Were you ever been behind on your rent? If so, explain.
*
Did you receive any complaints from the landlord?
*
Additional Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Additional Landlord
*
First
Last
Additional Landlord Phone:
*
Additional Date Occupied
*
What was reason for leaving this address?
*
Did any pets occupy this address?
*
Select value
Yes
No
Additional Rent
*
Were you evicted?
*
Select value
Yes
No
Did you receive any complaints from this landlord?
*
Were you ever been behind on your rent at this address? If so, explain.
*
Did you comply with all terms of this lease? If not, explain.
*
Do you have any additional addresses to add?
*
Select value
Yes
No
Additional Addresses
*
Have you ever been evicted?
*
Select value
Yes
No
A complete rental history for the previous FIVE (5) years is required. I acknowledge that failure to provide a complete rental history will result in denial.
*
I certify that I have provided a full and complete rental history.
*
I authorize verification of my rental history.
*
Current Employer
*
Employer Phone
*
Employer Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
I acknowledge that I will be required to submit verification of all income reported.
*
Are you able to provide copies of your three (3) most recent pay stubs?
*
Select value
Yes
No
Supervisor Name
*
First
Last
Position Held
*
Hire Date
*
Monthly Net Income
*
Other Income
*
Have you ever been slow in payment of rent or any other financial obligation? If so, explain.
*
Have you ever declared bankruptcy?
*
Select value
Yes
No
Is there anything else you would like us to consider in connection with your application?
*
I acknowledge that Wellco, LLC does business in accordance with the Fair Housing Act.
*
I authorize verification of the information provided on this form as to my rental history, income information, and credit report. I grant permission for Wellco, LLC to obtain a credit report and criminal background report.
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I acknowledge that in order to complete my application, I will have to submit a $30.00 application fee. The application fee is payable via PayPal or in person at the Wellco, LLC office. The application fee is utilized to complete background and credit checks. Payment is made via our website under the apply tab. I further knowledge of the application fee is non-refundable.
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In connection with my rental application, I understand that my consumer reports which may contain public record information may be requested. These reports may include the following types of information: names and dates of previous employers, public records, credit data, bankruptcy proceedings, election and criminal records, etc., from federal state and other agencies which maintain such records. Additionally, by signing this form I consent to receive marketing and other advertisements by phone and/or email.
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I authorize without reservation, any party or agency contacted by Wellco, LLC to furnish the above mentioned information.
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I understand that if my credit file is access, it will result in a hard credit inquiry. I hereby authorize procurement of consumer reports. If approved as a tenant, this authorization shall remain on file and shall serve as an ongoing authorization for Wellco, LLC to procure consumer reports at any time during my contract period.
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I understand that my application will not be processed until I provide copies of all documents required and submit the application fee. I understand that I must submit a copy of a government issued ID and copies of my three (3) most recent pay stubs and/or benefit letter. Documents may be emailed to leasing@wellcollc.com upon submission.
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Submit