RockfordRentals.Com Submission Form 

PRINT OUT THIS PAGE &  FAX TO 815-399-5583

Please write in the information requested and/or circle all that apply to your vacancy.  

Date:____________     

Address of Rental Property:

_______________________________________

Apt or Unit #__________

City_____________________ Zip   _______

Location of Property:   NE     SE     NW     SW 

(Circle one)          LP    MP    Rural   Other:_______

Rent Amount: $______Security Amt:$_______

(Short-term lease amount, list below)

Lease Term  1yr ____  6 Mo $______Mo.$______

Available Date to Move In:_________________

Type of Unit – Circle type & Level below:

House:  2 Story   Ranch   Tri-level  Other:_______

Duplex (side x side) or  2 Family (upper & lower)

4 Family: Ranch Style  or   Uppers & Lowers

6 /8 /12 Family: Ranch Style or Uppers & Lowers

Condo: Ranch Style or Uppers & Lowers

Other:___________________________________

# of Bedrooms  _______

(Please state if not all on one level)         

Main_____ Upper ____Lower______  

#  of Bathrooms_______

(Please state if not all on one level)

 Main_____Upper ____Lower______

Owner Name         ________________________

Address     _______________________________

City_____________________________________

State___________________zip_______________

Owner Phone #    ____________________

Cell Phone__________________________

E-Mail add.__________________________

Current Tenant Name:____________________

Tenant Phone Number:____________________

Tenant Move Out Date:___________________

Please write directions to unit in below:

_________________________________________

_________________________________________

_________________________________________

Other Comments about Unit

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

Utilities Paid by:   T=Tenant O=Owner

Gas________  Elec______Heat _______

Water______  Trash_____Sewer______

 Trash pick up day:_________

 Assoc. fees______ Other fees: _________

___________________________________

Garage: 1 Car ___ 2 Car ___ Attached: Y or  N

Off street parking: Y or N    Car Port: Y or  N

Basement_______ Finished: Y or  N or  Semi

Hardwood floors______ Carpet_____

Family Rm._____  Furnished Y  or  N

Laundry: Hookups: Y or  N   gas or electric (dryer)

washer/ dryer provided       Y or N  “As is” Y or N

                                Coin  N or Y 

Stove: Y or N                  Refrigerator: Y or N

Dishwasher Y or N         Microwave Y or N

Other: _______________________________

Central Air Y or N        Window Air Y or N                                   

Source of Heating: Gas___ Elec____ Steam___

Aprox. Cost per Month: Gas $_____ Elec $_____ 

Fireplace Y or N     wood____ gas_____

Deck Y or N             Porch Y or N            Patio Y or N

Balcony Y or N        Fenced Yard Y or N 

Pets____________ Pet Deposit $______

Pet Deposit Refundable or Nonrefundable

(Please circle or state if partial refund given)

Owner has reviewed or filled in and acknowledges all stated as factual.

(Owner’s signature)