Smith Property Rentals

Rental Application

Complete the form below to apply for one of our Brevard County single family homes. We'll review your application and follow up within 2 business days.

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All fields marked with * are required. Your information is kept confidential.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Driver's License #

Last 4 of SSN

Date of Birth *

Number of Occupants *

Pets (type and breed, or 'None')

Current Address

Street Address *

City *

State *

ZIP Code *

Rental History

Previous Landlord Name

Previous Landlord Phone

Previous Rental Address

Reason for Leaving

Employment & Income

Employment Status *

Gross Monthly Income *

Employer / Company Name

Supervisor

Supervisor Phone #

Job Title

Additional Income

Vehicle Information

Vehicle 1

Make

Model

License Plate

Vehicle 2 (if applicable)

Make

Model

License Plate

Emergency Contact

Full Name

Phone Number

Relationship

References

Please provide two personal or professional references (not family members).

Reference 1 — Name

Phone

Relationship

Reference 2 — Name

Phone

Relationship

Background Questions

Please answer all questions honestly. A "Yes" answer does not automatically disqualify your application.

Have you declared bankruptcy in the past seven years? *

YesNo

Have you ever been evicted from a rental property? *

YesNo

Have you ever willfully or intentionally refused to pay rent when due? *

YesNo

Have you ever been convicted of a felony? *

YesNo

Additional Information

Anything else you'd like us to know?

I authorize Smith Property Rentals to conduct a background and credit check as part of the rental application process. *