Residential Rental Application: Step 1 of 2

Required fields are marked with *

Contact Information
First Name *
Middle Name
Last Name *
Phone *
Social Security Number *
Driver License
Date of Birth *
Have you ever been convicted of a felony?
Yes No
Have you ever been evicted?
Yes No
If answer is Yes to either, please explain:
Closest Relative
Phone Number
Present Address
Address *
City *
State *
Landlord Name
Landlord Phone
Occupants Information
How many in your family?
Employment Information
Time of Employment
Employer Phone
Name: Relationship: Phone:
Name: Relationship: Phone:
Name: Relationship: Phone:
Vehicle Information
License Plate #
Add+ Add another Applicant  
I represent that the information provided in this application is true and correct to the best of my knowledge. I understand that this application is not a rental agreement. I Authorize the Landlord to perform a credit check and criminal history. I consent to the release of information relating to my credit and the information provided in this application. I understand that the information provided might be used by Landlord to determine whether to accept this Application. I authorize the Landlord to verify all the information given in this application is true including income, employment and rent history.
Electronic Signature *


NCDG Realty & Property Management Inc., will not discriminate against any applicant on the basis of any illegal purpose including race, color, religion, sex, national origin, age, disability of familial status. Such discrimination as the sole basis of refusal to rent is illegal throughout the United States. You can call the U.S. Department of Housing and Urban Development at 1-800-424-8590 for information about discrimination.


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3 Bed, 3 Bath
1738 Sq. Ft.

5180 Sweetleaf
Dayton, Ohio 45424

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