Benjamin Ventures
Rental Application
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  • Fill out the application below ( * required).
  • Incomplete applications will NOT be processed.
  • Upon submission, you will be directed to a webpage to pay the required $25 application fee.
  • The application fee is non-refundable.
  • If you just need to pay the application fee click here.
Property of Interest
Property Name/Address: *
Applicant's Personal Information
Last Name: * First Name: * Middle Name:
Social Security: * Birth Date: * Driver's License # & Issuing State: *
Cell Phone #: * Home Phone #: Email Address: *
Work Phone #: Do You Smoke? *
Yes No
Children Information
Names of Children: Children's Birthdate:
Emergency Contact Information
Emergency Contact's Name: * Contact's Relation to You: * Contact's Phone #: *
Contact's Other Phone #: Contact's Email Address: *
Pet Information
Do You Have Pets? * Number of Pets: Pet Type (Dog, Cat, etc):
Yes No
Pet Breed: Pet Size: Pet Age & Other Info:
Moving Information
What date will you move in? * How long do you plan to stay? * Why are you moving? *
Credit History
Have you ever filed for
bankruptcy? *
Date of bankruptcy? Have you ever been evicted from any tenancy
or had an eviction notice served to you? *
Yes No Yes No
Have you ever failed to pay rent when due? * Have you ever been convicted of a misdemeanor
or felony (other than traffic or parking violations)? *
Yes No Yes No
Current Residence
Street Address: * City: * State: * Zip Code: *
Do You Rent or Own? * Monthly Payment Amount? * How Long Have You Lived There? *
Rent Own
Landlord, Management or Mortgage Co Name: * Contact Phone #: *
Past Residence (required if less than 2 years at current residence)
Street Address: City: State: Zip Code:
Did You Rent or Own? Monthly Payment Amount? How Long Did You Live There?
Rent Own
Landlord, Management or Mortgage Co Name: Contact Phone #:
Current or Future Employer
Employer: * Occupation/Position: * How Long Have You Worked There? *
Street Address: * City: * State: *
Phone # To Verify Employment: * Supervisor's Name: Salary (indicate yearly, monthly, etc.): *
Past Employer
Employer: Occupation/Position: How Long Did You Work There?
Street Address: City: State:
Phone (Employment Verification): Supervisor's Name: Salary (indicate yearly, monthly, etc.):
Additional Income
Explain Additional Income: Amount Of Additional Income:
Vehicle Information
Vehicle Make & Model: * License Plate #: * State: *
Comments or Additional Information
Comments or Notes:
Applicant Consent Agreement
Electronic Signature *
I consent *
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Benjamin Ventures LLC
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