Midcoast Rentals Application
Midcoast Rentals, Inc

Bus: 207-522-6121
Fax: 207-221-1200
E-mail: info@midcoastrentals.com

All information you provide here will be strictly confidential. Midcoast Rentals will contact you regarding your rental application and social security number.
Full Name: *
Your answer
Co-Applicant's Name: (if applicable)
Your answer
Driver's License State: *
Your answer
Date of Birth: *
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E-mail Address:
Your answer
Driver's License #: *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
Address: *
Your answer
How Long at this Address?
(years/months)
Your answer
Please provide the following about your current Landlord:
Name, phone, email, fax (if available)
Your answer
Contact in Emergency: *
Name, address, phone, email
Your answer
Vehicle #1: *
Make, model, year, license plate #
Your answer
Vehicle #2:
Make, model, year, license plate #
Your answer
Have you ever been evicted from a rental property? *
Do you have a waterbed? *
Do you smoke? *
If applicant is accepted, all smoking must be done outside. Do you agree? *
Do you own pets? *
If you own pets, how many?
If you own pets, what type?
Your answer
Occupation:
Your answer
Employer:
Your answer
How Long There?
(years/months)
Your answer
Gross Monthly Income: *
Your answer
Additional Income:
Your answer
Additional Income Source:
Your answer
Why are you moving? *
Your answer
Current Address of where you are living: *
Your answer
Current Landlord's Name: *
Your answer
Current Landlord's Phone #: *
Your answer
Previous address of where you were living:
Your answer
Previous Landlord's Name:
Your answer
Previous Landlord's Phone #:
Your answer
Previous address of where you were living (2):
Your answer
Previous Landlord's Name (2):
Your answer
Previous Landlord's Phone # (2):
Your answer
Expected move-in date: *
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Name & relationship of every person to live with you, even if only temporarily (include name & ages of minors): *
Your answer
Have you ever filed for bankruptcy? *
Have you ever had to register as a sex offender? *
Do you have good credit? *
If no, please explain:
Your answer
Have you ever been convicted of a felony? *
If yes, please explain:
Your answer
Please fill out this background check
Which property are you interested in?
Your answer
I agree that I will be responsible for bed bug removal and/or any other pests that I bring into my rental. If they spread to other rentals I may be responsible for their removal as well. *
NOTICE TO THE RENTAL APPLICANT: We will collect your social security # privately and need to make a copy of your driver’s license. A credit/criminal report may be obtained in connection with this application. Upon request, I will be told if a credit/criminal report was obtained and given the name and address of the reporting agency providing the credit/criminal report investigation: I authorize a credit/criminal investigation based on the information voluntarily provided herein, which I attest is true and complete. By selecting "I agree" below, I certify that I have read and agreed to the preceding NOTICES TO THE APPLICANT. Potential tenants agrees to pay a small fee for the cost of background check. *
I agree to pay a mandatory $39.95 tenant screening charge upon request. Paid by credit card. *
I agree with no exceptions that to move in I will need: 1.) Valid credit card on file this way rent can be charged if payment is late. 2.) First & last month’s rent, security deposit. (same as one month’s rent) 3.) Money for a full tank of heating oil. (typically $300-$450 depending on current oil prices). Landlord will reimburse for oil left in tank when tenant moves out. *
Are you agreeable with our policies? *
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