Online Rental Application

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ONLINE RENTAL APPLICATION

Additional info can go here if needed

APPLICANT INFO

Name *

Middle name *

Last name *

Address *

City *

State *

Zip code *

Cell phone *

Work phone *

Email Address

Social Security Number *

Date of Birth *

List ALL states in which you have previously resided *

Additional residents (please list all that will live within the apartment)

First name

Middle name

Last name

Date of birth

Social security number

Gender (as listed on government issued ID)MaleFemale

Veteran/Military status

List ALL states in which this person has resided

PETS

List all pets

Type

Is your pet spayed/neutered?YesNoNot applicable

Is your pet current on all vaccinated?YesNoNot applicable

Upload pet license and records

Drag and Drop (or) Choose Files

Other information regarding your pet and any answers given above?

RENTAL HISTORY

Landlord business name

Current Landlord name

Landlord phone

Landlord address

rented since

PREVIOUS RENTALS

Previous landlord business name

Landlord name

Previous landlord phone

Landlord address

Rented from

INCOME SOURCE(S)

List ALL sources of incomeInclude all that is applicable including: interest/dividends, child support, social security, SSI, VA pension, retirement pension(s), other

Household member name

Employer/income source name

Employer/income source address

Employer/income source phone

Monthly income

ADDITIONAL INFORMATION

Has anyone listed in the resident section ever been evicted from rental housing? *YesNo

If yes, please explain

Has anyone listed in the resident section ever been convicted of a felony or other criminal act other than a traffic violation? *YesNo

If yes, please explain

Has anyone listed in the resident section ever been charged with possession, manufacture or sale of illegal drugs? *YesNo

If yes, please explain

Has anyone listed in the resident section ever been required to register on any Sexual Offender Registry list? *YesNo

If yes, please explain

5. If you are disabled, is your sole disability due to drug addiction or alcoholism? *YesNoNot applicable

Does anyone listed in the resident section require the use of a unit that is specifically designed for wheelchair accessibility? *YesNo

Do you have a housing voucher? *YesNo

If yes, which agency provides voucher?

ADDITIONAL CONTACTS

Please list two people we can call if you cannot be reached.

Name *

Phone *

Name *

Phone *

REQUIRED DOCUMENTS

Please upload the required application documents below.

Veteran: DD214 letter

No file chosen

Social Security Card

No file chosen

Copy/picture of government-issued ID or Drivers license (must include photo of primary applicant)

No file chosen

Copy of most recently filed tax return

No file chosen

AFFIRMATION OF APPLICATION INFORMATION

I/We certify that all of the above information is true and correct. I/We have no objections to inquiries being made for the purpose of verifying the statements made herein as well as verifying military service, checking my/our credit, landlord reference(s) and criminal history. I/We understand that I/We can be denied housing up to five years if I/We knowingly furnish false or incomplete information.

OPTION – A $26.00 non-refundable fee must be submitted with this application. Which way would you like to pay?Payment via credit card (Recommended. Use field below for payment)Send/drop off check or money order at WisVVA, 2919 W. Glenpark Dr., Suite #500, Appleton

A $26.00 non-refundable fee must be submitted with this application. Pay using credit card below. *