Roselli Realty Logo

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

Online Rental Application
Applicant must complete Part 1 and Part 2 before an agent will review the Online Rental Application

Part 1 - Please complete the application and click the "Submit" button at the bottom of this form. The "Application Confirmation" page will open confirming your Rental Application submission.
Part 2 -
Use the PAYPAL form at the bottom of the "Application Conformation" page to pay the processing fee. As soon a we are notified by PAYPAL the processing fee is paid an agent will review your Online Rental Application.


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 By*

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 By

Current Address*   Apt/Unit No.* 
City* State*   Zip Code*  
Own or Rent* 
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 or Rent* 
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?*    If "Yes" Describe Pets* (breed, male/female, sprayed/neutered, age, size/lbs)


Self Employed?*
Employer*
Address*
City* State*   Zip Code*  

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

Spouse Self Employed?
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
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 Work 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
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.

A PLEASE TYPE  "YES" 
IN BOX BELOW AND CLICK THE "SUBMIT" BUTTON.

I (WE) APPROVE ROSELLI REALTY APPLICATION TERMS Type in YES before submitting application


 
CLICKING THE "SUBMIT" BUTTON COMPLETES PART 1. NEXT THE "APPLICATION CONFIRMATION" PAGE WILL OPEN AND THE APPLICANT CAN PAY THE APPLICATION PROCESSING FEE USING THE PAYPAL FORM AT THE BOTTOM OF THE PAGE. THAT WILL COMPLETE PART 2 OF THE ONLINE RENTAL APPLICATION.