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For inquiries about the rental property,

Email Sheila Brown

Rental Application
Notice: All adult applicants (18 year or older) must complete a separate application for rental.
House Address*
Rent*
Start Date*
APPLICANT INFORMATION
Name*
First M.I. Last
Home Phone*
Work Phone*
Birth Date*
MM slash DD slash YYYY
Email*
CURRENT ADDRESS
Address*
Street Address City State ZIP Code
Date In*
MM slash DD slash YYYY
Date Out or Current Address*
Landlord Name*
First Last
Landlord Phone*
Monthly Rent*
Reason for Leaving*
PREVIOUS ADDRESS
Address*
Street Address City State ZIP Code
Date In*
MM slash DD slash YYYY
Date Out*
MM slash DD slash YYYY
Landlord Name*
First Last
Landlord Phone*
Monthly Rent*
Reason for Leaving*
OTHER OCCUPANTS
Last Names and Birth Dates of All Additional Occupants 18 Years or Older*
Last Names and Birth Dates of All Additional Occupants 18 Years or Younger*
PETS
The Landlord allows pets for 25$ per month, per pet fee. No reptiles.
Pets?*
Describe*
EMPLOYMENT & INCOME
1. Occupation*
Employer/Company*
Supervisor Name*
Monthly Salary*
Start Date*
MM slash DD slash YYYY
End Date or Currently Employed*
Supervisor Phone*
Employers/Company*
Monthly Salary*
Supervisor Name*
Supervisor Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
1. Other Income Descriptions*
Monthly Income*
2. Other Income Descriptions*
Monthly Income*
EMERGENCY CONTACT
Name*
First Last
Phone*
Relationship*
Name*
First Last
Phone*
Relationship*
PERSONAL REFERENCES
Name*
First Last
Phone*
Relationship*
Name*
First Last
Phone*
Relationship*
BACKGROUND INFORMATION
Have You Ever*
Filed for bankruptcy?
Willfully or Intentionally Refused to Pay Rent When Due? If Yes, Explain:*
Been Evicted from a Tenancy or Left Owing Money?*
- Yes
- No
If Yes, Please Provide Property Name, City, State and Landlord Name.*
Been Convicted of a Crime?*
- Yes
- No
If Yes, Please Provide Type of Offense, County, and State.*
VEHICLE INFORMATION
1. Make and Model*
Year*
License Number & State*
2. Make and Model*
Year*
License Number & State*
Other Vehicles*
SMOKING
The Landlord does not allow smoking in the rental property.
OTHER INFORMATION
How Did You Hear About This Property?*
Please Include Any other Information You Believe Would Help to Evaluate This Application*
PROOF OF INCOME
Please Attach Proof of Income to this rental application. Acceptable documents include: Pay stubs, Employer's letter/certificate, Bank statement Copy of Previous Year's Tax Return*
Drop files here or

Max. file size: 300 MB.
Pay stubsEmployer's letter/certificateBank statementCopy of previous year's tax return
AUTHORIZATION
Authorization*
I declare that the information I have provided is true and correct and contains no misrepresentations. If misrepresentations are found after a residential leave agreement is entered into between the Landlord and Applicant, the Landlord shall have the option to terminate the residential lease agreement and seek all available remedies. The Applicant authorizes the Landlord to verify all references and facts, including but not limited to, current and previous landlords, employers and personal references. The Applicant understands that incomplete of incorrect information provided in the application may cause a delay in processing or may result in the denial of the application.
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Email
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EMAIL

sbrown@btw.properties

PHONE

(308) 304-3580

ADDRESS

2621 W Hwy 30, Grand Island, NE 68803

PDF Download

Rental Application for Print Use

For inquiries about the rental property,

Rental Application

APPLICANT INFORMATION

CURRENT ADDRESS

PREVIOUS ADDRESS

OTHER OCCUPANTS

PETS

EMPLOYMENT & INCOME

EMERGENCY CONTACT

PERSONAL REFERENCES

BACKGROUND INFORMATION

VEHICLE INFORMATION

SMOKING

OTHER INFORMATION

PROOF OF INCOME

AUTHORIZATION

EMAIL

PHONE

ADDRESS

PDF Download