Roselli Realty Logo

office (480) 558-1300
fax (480) 558-1301
7345 E. Nopal Avenue |  Mesa | Arizona 85209-7222

Fax Rental Application

Please complete the rental application online. Pay the application fee using the PAYPAL form at the bottom of the page. Then print the form, sign and fax to 480-558-1301.

Individual applications are required for any occupant over the age of 18 years except spouse.
*(required items) For required items that do not apply type in "NA".


First Name*     
Middle Name*
Last Name*   
Social Security Number* (000-00-0000)  
Date of Birth* (
00/00/0000)
Driver License Number*   Driver License State*
License Expiration Date* (
00/00/0000)
Home Phone* (000-000-0000)    
Mobile Phone* (000-000-0000)
Work Phone (000-000-0000 ext 0000)  
Fax Phone (000-000-0000)  
Email Address*

Preferred Contact:*  Home Phone    Mobile Phone    Work Phone      Email

Spouse First Name      
Spouse Middle Name 
Spouse Last Name    
Social Security Number (000-00-0000)  
Date of Birth (00/00/0000)
Driver License Number   Driver License State
License Expiration Date (00/00/0000)
Home Phone (000-000-0000)   
Mobile Phone (000-000-0000)
Work Phone (000-000-0000 ext 0000)  
Fax Phone (000-000-0000)  
Email Address
Preferred Contact:  Home Phone    Mobile Phone    Work Phone     Email

Current Address*   Apt/Unit No.*  
City* State*   Zip Code*  
Own* 
Yes  No
Rent*
Yes   No
If Renting Please Select "Yes" To Approve Rental History Check*  Yes
Manager Name*
Manager Phone*
(000-000-0000)   Manager Fax* (000-000-0000)
Move In Date*
(00/00/0000)   Move Out Date* (00/00/0000)  
Reason For Move*

Prior Address*   Apt/Unit No.*  
City*   State*   Zip Code*  
Own* 
Yes  No
Rent*
Yes  
No
If Renting Please Select "Yes" To Approve Rental History Check*  Yes
Manager Name*
Manager Phone*
(000-000-0000)   Manager Fax* (000-000-0000)
Move In Date*
(00/00/0000)   Move Out Date* (00/00/0000)  
Reason For Move*

Pets?*
Yes   No  
If "Yes" Describe Pets
*(breed, male/female, sprayed/neutered, age, size/lbs)


Self Employed?*
Yes   No
Employer*
Address*
City* State*   Zip Code*  

Date Hired* (00/00/0000)   Position*
Employer Phone*
(000-000-0000)  
Supervisor Name*
Monthly Income*

Spouse Self Employed?
Yes   No
Employer
Address
City State   Zip Code  
Date Hired (00/00/0000)   Position
Employer Phone (000-000-0000)  
Supervisor Name
Monthly Income

Other Source of Income (child support, alimony, housing assistance)

Monthly Amount
Person to Verify
Phone (000-000-0000 ext 0000)
Other Source of Income (child support, alimony, housing assistance)

Monthly Amount
Person to Verify
Phone (000-000-0000 ext 0000)

Total Monthly Income All Sources*

Please list all your financial obligations including mortgages, auto loans, personal loans and credit cards
Loan *   Monthly Payment
Loan 2    Monthly Payment 
Loan 3    Monthly Payment 
Loan 4    Monthly Payment 
Loan 5    Monthly Payment 

Please list all proposed occupants in addition to yourself and spouse (Any occupant over the age of 18 must complete an application)
Name   Age
Name   Age
Name   Age
Name   Age
Name   Age
Name   Age

Please list closest family members not residing with you
Name*

Address*  Apt/Unit No.*
City*   State*   Zip Code*
Home Phone* (000-000-0000)
Name2
Address  Apt/Unit No.
City   State   Zip Code
Home Phone (000-000-0000)

Please list personal reference
Name*
Address*  Apt/Unit No.*
City*   State*   Zip Code*
Home or Mobile Phone* (000-000-0000 ext 0000)

Please list your personal vehicles
Vehicle Make*
  Model*   Year*
Color* License Number*   License State*
Vehicle 2 Make   Model   Year
Color    License Number   License State

Please answer the following questions
Have you or any occupant ever broken a lease?*
Yes   No
Date(s)*
(00/00/0000)
If "Yes" Give Details*

Have you or any occupant ever been convicted of a felony or crime?*
Yes   No
Dates(s)*
(00/00/0000)
If "Yes" Give Details*
Have you or any occupant ever been removed from a rental property by forcible detainer action or any other legal action?* 
Yes   No
Date(s)*
(00/00/000)
If "Yes" Give Details*

Please enter the rental property you are applying for
Address*
City*   Occupancy Date*
(00/00/0000)

Are you represented by a real estate agent? *
Yes   No  If "Yes" Give Details*
Agent's Name*
Agent's Company*
Agent's Company Phone*
(000-000-0000)
Agent's Mobile Phone*
(000-000-0000)

Please carefully read the following and approve Roselli Realty application terms

APPLICANT UNDERSTANDS THAT ROSELLI REALTY IS THE AGENT OF THE LANDLORD/OWNER EXCLUSIVELY. APPLICANT FURTHER UNDERSTANDS THAT OCCUPANCY IS LIMITED TO ONLY THOSE NAMES ON THIS APPLICATION. APPLICANT ACKNOWLEDGES THAT ALL INFORMATION ON THE APPLICATION IS TRUE AND ACCURATE. APPLICANT AUTHORIZES VERIFICATION OF ALL INFORMATION INCLUDING BUT NOT LIMITED TO CREDIT CHECKS, CRIMINAL CHECKS, EMPLOYMENT HISTORY AND RENTAL HISTORY BY ROSELLI REALTY AND/OR ITS EMPLOYEES OR AGENTS.  APPLICANT GIVES PERMISSION TO ROSELLI REALTY AND/OR ITS EMPLOYEES OR AGENT TO CONTACT THEIR REAL ESTATE AGENT, IF ANY, IN CONNECTION WITH APPLICANT'S APPLICATION, CREDIT HISTORY AND RENTAL HISTORY. ANY FALSE INFORMATION LISTED SHALL CONSTITUTE GROUNDS FOR REJECTION OF THIS APPLICATION, TERMINATION OF THE RENTAL AGREEMENT AND ANY RIGHTS OF OCCUPANCY AND THE FORFEITURE OF ALL PAYMENTS AND DEPOSITS.

APPLICANT UNDERSTANDS THE APPLICATION PROCESSING FEE IS NOT REFUNDABLE.  IF APPLICANT IS NOT APPROVED, THE APPLICATION FEE WILL NOT BE REFUNDED. IF APPLICANT IS APPROVED BUT FAILS TO ENTER INTO THE RENTAL AGREEMENT IN A TIMELY MANOR OR FAILS TO TAKE OCCUPANCY ON THE DATE SPECIFIED IN THE RENTAL AGREEMENT, ANY EARNEST MONEY, GOOD FAITH DEPOSITS OR SECURITY DEPOSITS WILL NOT BE REFUNDED.

APPLICANT MUST FIRST PAY APPLICATION PROCESSING FEE USING THE PAYPAL FORM AT THE BOTTOM OF THIS PAGE WHICH WILL LINK YOU TO PAYPAL. AFTER YOU RETURN TO THIS PAGE PRINT THE PAGE, SIGN AND FAX TO 480-558-1301. APPLICATION WILL BE REVIEWED AFTER PAYMENT IS CONFIRMED.

NON-REFUNDABLE FEES
APPLICANT'S NAME

You can return, print and submit this page after payment is completed.

I(WE) APPROVE ROSELLI REALTY APPLICATION TERMS

Signature
(Please sign and date after the form is printed)
 
Date
(00/00/0000)
Spouse Signature (Please sign and date after the form is printed)
 
Date (00/00/0000)

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