Eau Claire Realty

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3420 Mall Drive, Eau Claire, WI 54701  |  Licensed in the State of WI

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Available Rentals from Eau Claire Realty

Eau Claire Realty - Rental Application

Please Note: There is a $16 application fee that will need to be submitted via credit card or PayPal directly following this application. You will be redirected after you complete this form.

Property Address:


Applicant Information

First Name

Middle Name

Last Name

Date of Birth


Drivers License Number

All Past Names

Home Phone

Cell Phone

Other Occupants

Date of Birth

Relationship to Applicant


Rental/Residence History


Current Residence

Previous Residence

Prior Residence

Street Address


State & Zip

Last Rent Amount Paid


Phone Number

Reason for Leaving

Is/Was rent paid in full?

Did you give a notice?

Were you asked to move?

Dates of Residency

Name(s) in which the
utilities are now billed:


Employment History


Current Employment

Previous Employment

Prior Employment

Employed By


Employer Phone


Name of Supervisor

Monthly Gross Pay

Dates of Employment


Financial Information


Bank/Institution Name

Current Balance or Amount Owed

Savings Account

Checking Account

Credit Cards

Auto Loan


Vehicle Information

Please include vehicles belonging to other proposed occupants.





Plate Number


References & Emergency Contacts


Reference #1

Relative NOT Living With You

Emergency Contact




State & Zip

Phone Number

By submitting this application, you grant us permission to communicate with all the contacts listed in this section in the event we cannot locate you. Furthermore, if you abandon the apartment for any reason then you grant us permission to allow your relative listed about to remove all contents of the dwelling on your behalf.


General Information

Have you ever been served a late rent notice?

Do any of the people who would be living in the apartment smoke?

How long do you think you would be renting from us?

Have you ever filed for bankruptcy? If so, when?

When would you be able to move in?

Have you ever been convicted of a felony?

Have you ever been served an eviction notice? If so, when?

How many pets do you have (List type, breed, weight, & age)?

Have you had problems with you current apartment or landlord (Please explain)?

Why are you moving from your current address?

List any verifiable sources and amounts of income you wish to have considered (optional):

Have you been a party to a lawsuit in the past? If yes, please explain why:

Is there anything negative we will find in a credit or criminal background check?

How did you hear about this apartment?

Do you have an e-mail address we can reach you at?


Agreement & Authorization Signature

I believe that the statements I have made are true and correct. I hereby authorize a credit and/or criminal check to be made, verification or information I provided, and communication with any and all names listed on this application. I understand that any discrepancies or lack of information may result in the rejection of this application. I understand that this is an application for an apartment and does not constitute a rental or lease agreement in whole or part.

We are required to notify you that as part of our procedure for processing your application, we may investigate your credit history, employment history and general background. By signing below, you hereby grant permission for us to do so. In addition, signing below certifies that all of the above information is true, correct and complete to the best of your knowledge.

Application Screening Policies:

  1. Applicants rent cannot exceed 1/3 of monthly income
  2. Applicants credit history must reflect positive payment history
  3. Applicant with outstanding housing collections or judgments will be denied
  4. Positive past housing references are required
  5. Applicants will be screened thorough the National Sex Offender Registry
  6. All information must be completed and the application fee paid to begin screening

Full Name


Confirmation Code

By typing your name in the field above, you accept that it acts as your digital signature.

Submit Application