Rental Application

Rivers Bend Mobile Home Park

Today's date______ Occupancy date desired_________
Rental price range_________ Trailer ________ Cabin ________ Lot space _______
Applicant's personal information
Last name __________________ First __________________ Middle ____________
Birth date ___________ Driver's License/ID Number/State _____________________
Social security number ____________ Phone ____________Email address _________________
Additional Occupants (List each occupant's name & their relationship below, including children)
______________________________________________________________________________________________

How long do you plan on living in the next rental dwelling that meets your needs? ____________
Would you like to purchase a trailer home in the next 2-3 years? ______ If so, what size? ______
Do you have renter's insurance? ______ Do you have any water-filled furniture? ______
Have you ever broken a lease? _______ Have you ever refused to pay rent for any reason? _____
Have you ever been evicted or asked to leave a rental unit? ____ Ever filed for bankruptcy? ____
Ever been convicted of a crime? ____
Do you give us permission to do a criminal background check? Yes ____ No ___
Do you give us permission to do a credit report check? Yes ____ No ___
Do you give us permission to check your references and verify employment? Yes ____ No ___
Currently have any utilities in your name? _______ Current telephone service in your name? ___
Do you know of anything or any reason which may interrupt your ability to pay rent? _________

Residence history
Present street address ____________________________________________________________
City _____________ State _________ Zip ________
Dates lived at this address _________________________ Own? ___ Rent? ____ Occupy? ____
Current phone _________________ How many pets do you have? ____ Type? _____________
Name of present landlord/Mortgage company? ________________________________________
Landlord's phone ______________ Monthly payment __________
Reason for moving _______________________________ Is your rent/mortgage current? ______
Number of late payments? __________ Security deposit amount currently held by landlord?____
Previous residence address ________________________________________________________
Previous landlord _______________________ Previous landlord's phone __________________
Dates at this address _________________ reason for moving? ____________________________
Was your full security deposit returned? _____ Monthly payment _____ # of late payments ____

Income History
Applicant's current employment status?
Fulltime ____ Part-time (less than 32 hours) ___ Student ___ Retired ___ Self-employed___
Unemployed ____ Other ___
Primary source of employment
Applicant employed by ________________________________ Supervisor's name ________
Average weekly hours ____ How long at this employer ___________
Address _____________________________________________________________________
Phone ________________ Position ___________________ Salary _____________________
Please indicate monthly average take-home pay _______________________

Additional employment
Applicant employed by ________________________________ Supervisor's name ________
Average weekly hours ____ How long at this employer ___________
Address _____________________________________________________________________
Phone ________________ Position ___________________ Salary _____________________
Please indicate monthly average take-home pay _______________________

Additional Income
What is the source? _____________________________ Amount __________
(Child support, alimony, or separate maintenance need NOT be disclosed unless you desire this additional income to be considered for qualification)
Contact person ___________________________ Phone __________________
How long have you been receiving this income ___________ How long do you expect it to continue _____________ Is there any reason it would stop _____________

Vehicles
Number of vehicles you'll have on property _________ Valid registration and operable? _____
Do you have any commercial vehicles, RV, campers, boats or motorcycles? _______________

Vehicle 1 (make, model, color, year) ______________________________________________
(Only cars listed here are authorized to be kept on premises)
Plate number _______________ Financed/leased through _____________
Contact and phone number ________________________________
Acct # ____________________ Monthly payment ____________________

Vehicle 2 (make, model, color, year) ______________________________________________
(Only cars listed here are authorized to be kept on premises)
Plate number _______________ Financed/leased through _____________
Contact and phone number ________________________________
Acct # ____________________ Monthly payment ____________________

Personal/Professional reference
Character/personal reference:
Name ________________________________________________________________________
Address ______________________________________________________________________
Relationship? _________________________ How long? ____________ Phone ______________

Professional reference
Name _______________________________________________________________________
Address ______________________________________________________________________
Relationship? _________________________ How long? ____________ Phone ______________

Emergency contact ____________________________________ Relationship _________
Address _____________________________________________________________________
Phone _________________ Second phone __________________

If we have a question regarding this application please furnish the best contact phone number:
Day ________________________
Night _______________________

Thank you for completing an application to rent from us.
By signing below, applicant hereby represents all information on this application is true, complete, and hereby authorizes verification of information for rental consideration. If any information is found to be inaccurate, the application will be rejected and any subsequent rental agreement becomes void. False and misleading statements will be sufficient reason for immediate eviction and loss of security deposit.

Applicants signature ________________________________ Phone _________ Date _______
Print name ________________________________________
Additional applicants signature___________________________Phone _________ Date _____
Print name ________________________________________

Mail completed application to:
Rivers Bend Mobile Home Park
54 Belfry Highway Cabin #3
Cody, WY 82414

Or call our park manager: at 307-587-9089 and arrange a drop-off point