Old Mill Realty
Old Mill Realty
(801) 226-7838 Sales
(801) 762-0411 Rentals
PO Box 693
Orem, UT 84059

"It's the Experience"
Celebrating our 40th year
Rental Application
Please complete the rental application below in it's entirety. By submitting this application I give Old Mill Realty authorization to verify the information and to run a credit & criminal report profile as part of my application for a property to rent. ANY false or misleading information listed will be sufficient cause for IMMEDIATE rejection of this application, no exceptions.Fiance or single roommates must fill out separate applications.

Address of Property applying for
State:   Zip:
Date needed & anticipated length of occupancy
Date of Birth
Social Security Number
Drivers License and state
Present phone #'s
Present Address
How Long at Present Address?
Landlord/Agent & phone #
How long at previous address?
Previous Address
Previous Landlord or Agent & phone #
Name of Employer, Type of Business & Position Held
Employer Address, Phone, Name & Title of Supervisor
Monthly Gross Income
How Long Employed?
Other Occupants: Name & age of each
Name of Spouse
Social Security Number
Date of Birth
Driver's License
Spouse Current Address
Spouse Current Landlord name & phone number:
Spouse length at current address
Spouse employer, type of business & position held
Spouse employer address,phone, name & title of supervisor
Monthly Gross Income
How Long Employed?
List 2 Personal References, City/State, Phone & Occupation
List 2 Nearest Relatives, City/State, Phone & Relationship to you
Car #1 Year, Make, Model, License #
Car #2, Year, Make, Model. License #
Have you ever filed for bankruptcyyes
Do you have any kind of pets? yes
If Yes to pets: Type, Size, Number
Have you ever been evicted? yes
Have you ever willfully & intentionally refused to pay any rent when due? yes
I authorize Old Mill Realty to verify the above info, run a credit report profile & run a background check. yes
Email Address