Westrom Realty
Property Management

Rental Application Form

 

 

 

APPLICATION FOR OCCUPANCY IN

Co-Tenant's Name

Phone Contacts

Email Contact:

Previous Location Information

Applicant's Information

Co-Tenant's Information

Household Member

Tenant's Information

Co-Tenant's Information

Which Of The Following Units Are You Interested In? (check one)

I (We) certify this housing is/will be my (our) permanent residence.

I (We) do/will not maintain a separate subsidized rental unit in a different location.

I (We) certify all household and income information is correct.

Other Information:

List all cars, trucks, or other vehicles owned. Parking will be provided for one vehicle.

In case of emergency, etc., whom to contact: (parents, relatives, friends, etc.)

Tenant's Emergency Contact Information
Co-Tenant Emergency Contact Information

This is a preliminary application and grants no lease or renting rights. The management reserves the right to approve or disapprove any application upon a thorough check of the information supplied. I authorize the management to conduct a credit check, landlord reference check, and personal reference check of myself (the applicant) and listed household members, when being considered for an apartment. If occupancy has not transpired by Date of Occupancy Desired, it is my responsibility to reaffirm any future interest. I acknowledge that certain restrictions may apply as pertains to occupancy and other housing requirements as determined by management, local ordinances, state laws and USDA - Rural Development. By my signature below, I acknowledge that I agree to this Applicant Statement and that the information I provided on this form is true and correct.

(This application valid for one year)
Westrom Realty, Inc.
1025-19th Ave. SW
Willmar, MN 56201

The following information is requested by the Federal Government in order to monitor compliance with the Federal Laws prohibiting discrimination against applicants seeking to participate in this program.. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin and sex of an individual applicant on the basis of visual observation or surname.

TENANT CERTIFICATION SUMMARY WORKSHEET

  1. Periodic payments from:

  2. Income:

    • Gross wages or salary

  3. Assets:

  4. Actual Income from Assets (Interest):

  5. Medical Expenses (Elderly and Disabled):

LANDLORD STATEMENT
(A) This section to be completed by applicant:

- -

I authorize the release of the information on this form to the management for determining eligibility.

The person named above has applied for an apartment, and has authorized us to request of you, as landlord, information relating to his/her residence under your management. Your prompt response to the information requested below is necessary for a complete evaluation of the applicant. Your response will be kept confidential except upon request of the applicant. Please complete the following information and return to: Westrom Realty, Inc., 1025- 19th Ave. SW, Willmar, MN 56201. A return envelope is enclosed for your convenience. Thank you for your cooperation.

Sincerely,

(B) This section to be completed by Landlord:

Dates applicant lived in your apartment complex:

Rent Payment:

Caring for the unit:

General: