Suite #266 6671 E. Baseline Road #105 Mesa, Arizona 85206 (480) 558-1300 | Fax (480) 558-1301 roselli@rosellirealty.com
Individual applications are required for each adult occupant except spouse.
First Name	.	Spouse First Name	.
Middle Name	.	Spouse Middle Name	.
Last Name	.	Spouse Last Name	.
Social Security Number	.	Social Security Number	.
Date of Birth	.	Date of Birth	.
Driver License No.	.	Driver License No.	.
License State	.	License State	.
License Expiration Date	.	License Expiration Date	.
Home Phone	.	Home Phone	.
Work Phone	.	Work Phone	.
Cell Phone	.	Cell Phone	.
Current Address	.	Prior Address	.
Unit #	.	Unit #	.
City	.	City	.
State	.	State	.
Zip Code	.	Zip Code	.
Manager's Name	.	Manager's Name.	.
Manager's Phone	.	Manager's Phone	.
Date In	.	Date In	.
Date Out	.	Date Out	.
Rent Amount	.	Rent Amount	.
Reason For Move	.	Reason For Move	.
Pets	Yes __  No __	Describe Pets	.
Will You Have Liquid Filled Furniture	Yes __  No __	Describe Furniture	.
Self Employed	Yes __  No __	Spouse Self Employed	Yes __  No __
Employer	.	Spouse Employer	.
Address	.	Address	.
City	.	City	.
State	.	State	.
Zip Code	.	Zip Code	.
Date Hired	.	Date Hired	.
Position	.	Position	.
Department	.	Department	.
Supervisor Name	.	Spouse Supervisor Name	.
Employer Phone	.	Spouse Employer Phone	.
.
Other Source of Income	.	Other Source of Income	.
Amount	.	Amount	.
Person to Verify Amount	.	Person to Verify Amount	.
Phone Number	.	Phone Number	.
Total Monthly Income	.	Total Monthly Income	.
Name of Bank	.	Name of Other Bank	.
Bank Address	.	Other Bank Address	.
City	.	City	.
State	.	State	.
Zip Code	.	Zip Code	.
Checking Account No.	.	Checking Account No.	.
Savings Account No.	.	Savings Account No.	.
.
Please list all your financial obligation below including charge cards, auto loans, personal loans etc.
Loan No. 1	.	Loan No. 3	.
Loan No. 1 Payment	.	Loan No. 3 Payment	.
Loan No. 2	.	Loan No. 4	.
Loan No. 2 Payment	.	Loan No. 4 Payment	.
.
Please list all proposed occupants in addition to yourself and spouse
Occupant No 1. Name	.	Occupant No. 3 Name	.
Occupant No. 1 Age	.	Occupant No. 3 Age	.
Occupant No. 2 Name	.	Occupant No. 4 Name	.
Occupant No. 2 Age	.	Occupant No. 4 Age	.
.
Please list closest family member not residing with you
Name	.	Name	.
Address	.	Address	.
City	.	City	.
State	.	State	.
Zip Code	.	Zip Code	.
Phone Number	.	Phone	.
Relationship	.	Relationship	.
.
Please list personal reference
Name	.	Name	.
Address	.	Address	.
City	.	City	.
State	.	State	.
Zip Code	.	Zip Code	.
Phone Number	.	Phone Number	.
No. Years Known	.	No. Years Known	.
..
Automobile Make	.	Automobile Make	.
Model	.	Model	.
Year	.	Year	.
License Number	.	License Number	.
License State	.	License State	.
..
Have you ever been convicted of a felony?  Yes __  No __  Date  ____________ Please give details
Have you ever broken a lease prior to the termination?  Yes __  No  __  Date ___________ Please give details
Have you ever been removed from a rent by a forcible action or any other legal action?  Yes __  No __ Please give details
.
Rental Address	.	Total Monthly Rent	.
City	.	Total Security Deposit	.
Zip	.	Non Refundable Deposit	.
Occupancy Date	.	Non Refundable Pet Deposit	.
.
Applicant understands that Roselli Realty is the agent of the Landlord/Owner exclusively. Applicant further understands that occupancy is limited to only those names on this application.  Applicant acknowledges that all information listed on the application is accurate.  Applicant authorizes verification of all information including credit check and rental history reports by Roselli Realty and/or its agents.  Any false information listed shall constitute grounds for rejection of this application, termination of rental agreement and right of occupancy and forfeiture of deposits. Applicants understands the processing fee of $35 per individual and $50 per married couple is not refundable.  If applicant is not approved, the application fee will not be refunded. If applicant is approved but fails to enter into the rental agreement or fails to take occupancy on the date specified in the rental agreement, any earnest and good faith deposit will not be refunded. Payment can be made with cash, cashiers check or charge card – no personal checks.
.. Applicant authorizes payment of $ _____ by Mastercard Visa Account No. ___________________________ Expiration Date _____ 20 ___
Applicant Signature	.	Date	.
Spouse Signature	.	Date	.
.