Rental Application for Champaign Urbana Home Rental

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To apply, please submit the Online Rental Application below.

If you prefer a paper copy, you can download the rental application, complete it, and return it to us.
(This is not needed if you fill out your application online).

Online Rental Application

(Please use a separate application for each adult if not married to the co-applicant)
Property Location*
Requested Move-in Date*
Rental Rate $
Deposit Amount $
How long do you anticipate living at this house?*
Would you like to sign a lease for 1 or 2 years?*
Name*
First Middle Last
Soc. Sec#*
Driver’s License Number
Email*
Phone #*
Other Residents
NAME RELATION SS# (Spouse only) EMAIL (Spouse only)
Pets - $300 One time pet fee due on move-in day (2 pets)
Type of Pet / Name Breed
Present Address*
Street Address City State / Province / Region ZIP / Postal Code
Current Landlord or Manager
Company / Name & Last Name Address, State & Zip Code Phone # Your Monthly Rent $
Length of Occupancy Reason for Leaving
Previous Landlord or Manager
Name & Last Name Address, State & Zip Code Phone # Your monthly Rent $
Length of Occupancy Reason for Leaving
Applicant's Present Employer
Company Name Address, State, Zip Code Supervisor's name Phone #
Position Length of Employment
Monthly Income (gross) $ How many hours/week?
Other Income / Spouse's Present Employer (if applicable)
Company Name Address, State, Zip Code Supervisor's name Phone #
Position Length of Employment
Monthly Income (gross) $ How many hours/week?
Applicant's Previous Employer
Company Name Address, State, Zip Code Supervisor's name Phone #
Position Length of Employment
Monthly Income (gross) $ How many hours/week?
Vehicles
Year Make Model License #
Emergency Contact*
Name & Last Name Address, State & Zip Code Relationship Phone #
I declare the foregoing information is true and correct, and I hereby authorize you to conduct an employment, credit, background, and tenant history check. I understand that falsification of the above information is grounds for immediate termination of my lease by landlord. The undersigned agree and assume joint and several responsibility for all debts incurred by them payable to the lessor by the renting of this unit. This form shall be attached and become part of the lease.

By submitting this application I am giving ChampaignUrbanaHomeRental/Mira Vista Properties permission to run a background check on myself and any co-applicants and co-signers.

Application Fee: $25.00 per application to Mira Vista Properties. The fee will only be refunded if the application is not processed. Please send your payment through Paypal at jyfairbanks@gmail.com or Venmo @JamieandYolanda-Fairbanks or by mailing a check to Mira Vista Properties, PO Box 363, Savoy IL 61874.
Applicant’s signature*
Date*
MM slash DD slash YYYY
Spouse (if applicable)
Date
MM slash DD slash YYYY
Security Deposit (equal to 1 month’s rent) is due at the time the lease is signed. Utilities will need to be in tenant’s name on the 1st day of the lease.
Comments: Is there anything you would like us to know about your application?

NAME	RELATION	SS# (Spouse only)	EMAIL (Spouse only)

Type of Pet / Name	Breed

Year	Make	Model	License #