LandLord

LandLord Name: Unison Health

Address: 1425 Starr Avenue, Toledo OH 43605

Phone: (419)936-7356

 

Rental Property Information

Rental Property Address
Application to Rent suite#:
Anticipated Possession Date
The Term of tenancy will be Month to Month tenancy starting on:

The Monthly Rent will be $300.00

Initial Security Deposit: $150.00

Applicant's Personal Information

Applicant's Name
Date of Birth
Phone
Alternative Phone
Email(Optional)
Social Security Number
Marital Status
 single
 married
 divorced
 separated
Is English your primary language
 yes
 no
If no, what is your primary language?
Are you a US Citizen?
 yes
 no
Are you a Veteran
 yes
 no
Do you have any medical conditions? (type no if not applicable)
Do you have any allergies? (type no if not applicable)
Are you recieving MH or SUD services currently?
 yes
 no
if yes where?

Residential History

Present Address
City
State
Zip
How long at this Address?
Landlord/lessor?
Landlord/lessor phone?
 
Previous Address
City
State
Zip
How long at this Address?
Landlord/lessor?
Landlord/lessor phone?
 
Previous Address 2
City
State
Zip
How long at this Address?
Landlord/lessor?
Landlord/lessor phone?

Details of Employment

Employer
Position
Hire Date
Supervisor's Name
Phone
Salary

(if employed less than one year with present employer, please provide previous employer.)

Employer
Position
Hire Date
Supervisor's Name
Phone
Salary

Other Sources of Income

Select any incomes sources that apply to you:
 Student Loans
 Pension Benefits
 Social Assistance
 Other
Please Provide contact person who could verify the amount of income you receive:

Vehicle Information

Make/Model
Year
License Plate Number
Driver's License Number

(If you have a second vehicle enter below.)

Make/Model
Year
License Plate Number
Parking stall required?
 yes
 no
Additional stall required? (Subject to availability)
 yes
 no

Banking Information

Banking Intituion
Bank Address
Bank Phone

(if you bank with more than one institution, please list second bank below)

Banking Intituion
Bank Address
Bank Phone

References

Name
Phone
Name
Phone

Emergency Contact

Name
Relationship
Phone

Criminal & Credit Background Check Authorization 

Is there anything negative that we may find in our criminal or credit background check that you want to comment on?

I declare that the information I have provided is accurate. I authorize the individual or organization to whom this application is submitted to: (a) contact my references and all other persons that I have named in this application; and (b) perform a credit and/or criminal check to assess my suitability as a tenant/lessee.

Date