Indian Peaks Real Estate Services, Inc.
A Full Service Real Estate and Property Management Company 

Rental Application

Rental Application For:    _______________________________________________________

Please return the completed Application to:  Indian Peaks Real Estate Services, LLC,

                                                                              P.O. Box 957, Nederland, CO, 80466

              (303) 974-1109 –fax, –email, (303)258-0656-phone

NOTE:  Each Applicant, eighteen (18) years of age or older, who will be residing in the Premises, MUST fill out a SEPARATE
              Rental Application.  If additional space is needed, please write on the back of the form.


Applicant’s Name:                                                                                  Date of Birth:                                          SS#:                                     

Driver’s License No.:                                                State:                       Other Photo ID:                                                                                   

Phone:                                                       Cell:                                                         E-Mail:                                                                                 

Vehicle Make:                                           Year:                       Color:                      License Plate:                                          State:                    

If you are a full-time student, please complete the following:

Permanent Address:                                                                                                                                                                                               

                                   Street                                                                    Apt.#       City                                         State          Zip

Mother’s Name:                                                                                                                                                                                                     

Mother’s Address:                                                                                                                                                                                                 

                                   Street                                                                    Apt.#       City                                         State          Zip

Father’s Name:                                                                                                                                                                                                       

Father’s Address:                                                                                                                                                                                                   

                                  Street                                                                     Apt.#       City                                         State          Zip

Emergency Contact (if other than Parents):

Name:                                                                                                                                        Relationship:                                                        

Address:                                                                                                                                    Phone:                                                                  

                   Street                                    Apt.#       City                         State          Zip

Other Occupants:

Name:                                                                                        Relationship:                                                           DOB:                                   

Name:                                                                                        Relationship:                                                           DOB:                                   

Who will be the Main Resident Contact Person:                                                                                       Phone:                                                  


Resident History – Please Complete for Past 5 Years


Current Address:                                                                                                                                                                                                

                                Street                                       Apt.#       City                                         State          Zip                           Rental Dates


Landlord’s/Manager’s Name/If Dorm, R.A.’s Name                                               Phone                                                      Rental Dates

Monthly Payment:                                    Reason for Moving:                                                                                                                             

Previous Address:                                                                                                                                                                                                

                                 Street                                                                      Apt.#         City                                       State          Zip


Landlord’s/Manager’s Name/If Dorm, R.A.’s Name                                               Phone                                                      Rental Dates

Monthly Payment:                                    Reason for Moving:                                                                                                                             

Previous Address:                                                                                                                                                                                                

                                 Street                                                                      Apt.#         City                                       State          Zip


Landlord’s/Manager’s Name/If Dorm, R.A.’s Name                                               Phone                                                      Rental Dates

Monthly Payment:                                    Reason for Moving:                                                                                                                             





If you answer “Yes” to any question, please explain below and on the back of form if more space is needed.  Have you ever: 

Been evicted from any leased premises?   Yes _______  No  _______

Broken a rental agreement?                         Yes _______ No  _______

Filed for bankruptcy?                                 Yes _______ No  _______

Appeared before CU Judicial Affairs?       Yes _______ No  _______

Been charged with a violation in ANY Court, including Municipal Court, other than a traffic violation?   Yes _______  No  _______

Been convicted, pleaded guilty or no contest, received a deferred sentence, deferred prosecution, diversion, continued adjudication, continued petition, of any felony or misdemeanor?   Yes _______  No  _______

Are you registered or under consideration for registration as a sexual offender?  Yes ____  No  ____   If yes, where:                                        

   If yes, type of offense:                                                                                                                                                                                        

Are you currently facing prosecution for any misdemeanor or felony?  Yes _______  No  _______




Employment & Financial Information


Present Employer:                                                                                                                    Position:                                                               

Business Address:                                                                                                                                    Work Phone:                                                        

                                Street                                       City                           State      Zip

Name of Supervisor:                                                                                 Phone:                                                     Employed Since:                  

Gross Monthly Income:                                            Additional Income:                                                  Source:                                                 

Name of Bank:                                                          Address:                                                                                  Phone:                                  

Checking Acct No.:                                                                                   Savings Acct No.:                                                                                


Other Information


Are you a student?  Yes _______  No  _______  If Yes, circle year in school at time of move-in:       Soph.      Junior      Senior      Graduate

List ANY other names you have used, including maiden name:                                                                                                                            

Do you require any special Accommodations?   Yes _______  No  _______

Do you smoke?   Yes _______  No  _______

Do you intend to have pets on the premises?   Yes _______  No  _______  If yes, how many?                           

Type/Breed:                                                               Age:                        Weight:                                    Color:                                                   


Deposit and Fees                                                                                                                            Monthly Rent: $


I understand the application fee is a non-refundable payment for a credit, background and criminal check and processing fee for this Application and such sum is not a rental payment or security deposit.  This amount will be retained by Owner/Agent regardless if the


I understand the deposits and fees to be:   Non-Refundable Application Fee:  $                     40.00         Other:  $                N/A                        

All monies deposited with Owner/Agent, less the non-refundable application fee, will be refunded within seven (7) business days if the Application is denied.  Owner/Agent will notify Applicant of acceptance or denial via phone, fax, email and/or mail.  If the Application is accepted and the Applicant fails to sign the Lease within ___7__ calendar days of notification of acceptance of the Application, the deposited amount may be retained by Owner/Agent as liquidated damages.  If Applicant is accepted as a resident and enters into a lease agreement, this document shall become part of the lease. 



Disclosures of Information


I warrant and represent the information provided on this application to be true and correct.  I authorize Owner/Agent to make such investigation into Applicant’s credit, background, employment, rental and criminal history, as Owner/Agent may deem appropriate.  Applicant hereby releases all parties from liability for any damage that may result from furnishing such information to Owner/Agent.  Owner/Agent shall have the continuing right to recheck updated rental application, credit, background and criminal information.  If approved, Applicant shall have a continuing and on-going duty to update all of the information provided on the Application.  Applicant acknowledges that Owner/Agent may enter into a Lease in reliance on the information contained in Applicant’s rental application and any and all other information provided to Owner/Agent by Applicant.  Applicant shall promptly notify Owner/Agent in writing of any subsequent change in the information provided by Applicant on Applicant’s application.  If Applicant is approved, Owner/Agent shall have the right to terminate Applicant’s tenancy on three days notice to quit if:  1) it is determined that Applicant provided false or misleading information on this Application, or 2) the Application information is no longer correct, for example, Applicant is convicted of a sexual offense after moving into the Premises.  Errors, omissions, or misstatements by Applicant shall provide Owner/Agent with the option to terminate the Lease upon three days notice to quit.


Owner/Agent does not have a duty to verify, and does not represent or promise that he/she will verify, the accuracy or the answers provided in the Application of any applicant.  Furthermore, Owner/Agent has do duty, and expressly disclaims any obligation, to perform a criminal background check on each applicant.  Owner/Agent does not represent or guarantee that all residents have no prior criminal record or background.


Owner’s/Agent’s approval or denial of this Application is based on information provided by independent third parties.  Owner/Agent makes
no representation as to the accuracy of the information that Owner/Agent obtains from third parties in approving or denying this Application.  Owner/Agent hereby disclaims any liability for the accuracy of such information that Owner/Agent obtains pursuant to Applicant’s consent.

Authorization of Release

To Whom It May Concern:

I hereby allow Rental Services, Inc. to verify my employment and rental reference(s) and/ or run a credit and criminal history check.  I am aware that they may ask several questions regarding my background and I give them my permission to do so.


Please be advised that I, __________________________, authorize release of information to Rental Services, Inc., your prompt response to any/ all questions is greatly appreciated.


Applicant Signature: ________________________________Printed Name: __________________________   Date: ______________


Owner/Agent/Broker Signature: ______________________ Printed Name: ____Wendy Williams___ Date: _______________



Rental Reference Information


This rental reference is being requested for the Applicant identified above regarding their tenancy at:


Address:                                ________________________________________________________________________

Street                       Apt.#       City                                         State          Zip                   Rental Dates


Specific Information Requested:


Express Report                                                                                                                                                                                                    



Please furnish the requested information to:


Company:  Indian Peaks Real Estate Services, LLC

Phone:  (303) 258-0656  Fax:  (303) 974-1109  E-Mail:





Licensed Real Estate Broker and Prospective Resident Relationship Disclosures


The Broker and Prospective Resident referenced below have NOT entered into a Prospective Resident Agency Agreement.  The working relationship specified below is for a specific property at the address of:



Owner/Agent/Broker is the agent for the property owner, and Broker represents only the landlord’s interests in this transaction.  Owner/Agent has the authority to manage and administer the Premises and Property and to enter into, administer and enforce provisions of this Application and any subsequent Lease that may result from the approval of this Application and is not considered an agent for the Applicant/Resident.  As
a prospective resident, you are a customer in this transaction.  A customer is a party to a real estate transaction with whom the Broker has no brokerage relationship because such party has not engaged or employed the Broker, either as the party’s agent or as the party’s transaction-broker.  If you desire representation, Broker recommends that you obtain either your own Broker or legal advice from an attorney.


Different brokerage relationships are available that include seller agency, landlord agency, buyer agency, tenant agency or transaction-brokerage.  The Colorado Real Estate Commission has a form setting forth the definitions of these working brokerage relationships (Form DD25).  Upon request, Broker will provide the working definitions of the various brokerage relationships to you.






Signature of Applicant                                                            Date                            Printed Name



Signature of Owner/Agent/Broker                                          Date                            Printed Name


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