Please fill out the form below or click here to PRINT our application form. After completing the printable application form, please bring into our Spencer, IA office M-F, 8:30-5:30, email it to, or fax to (712) 262-4021 attention: JHC

Jacobsen Homes Corp.
1015 Grand Avenue
PO Box 180
Spencer, IA  51301-0180
Phone: (712) 262-2612, #4
Toll Free (800) 728-9157 #4


Each adult applicant is required to fill out the information requested on this form.

Names and Relationship of everyone who will occupy dwelling. Please include ages of minor children.

Rental Reference Information (Last 2 years)
(IMPORTANT: Must have phone number to check landlord reference. This application will not be processed without it.)
(IMPORTANT: Must have phone number to check landlord reference. This application will not be processed without it.)

Background Information

Financial Information

Vehicle Information



Additional Information

Tenant Rules and Regulations
  1. No criminal activities allowed on premises.
  2. ALTERATIONS: Do not do any painting nor make any alterations of any kind without prior written approval from Landlord. Not to use nails, tape, gum based adhesives nor fasteners other than hooks with small nails.
  3. CHILDREN: do not allow your children under the age of twelve (12), under any circumstances, to remain unattended on the premises.
  4. Do not allow your children or visiting children to play in the hall, entrances or laundries or disturb other residents. Daycare not Allowed.
  5. CLEANLINESS/LITTER: To keep that part of the premises that tenant occupies and uses, safe, sanitary and clean as possible and not to litter the hallways, entrances, laundries, parking areas or grounds.
  6. CONDUCT: To see that the conduct of himself/herself, the family and guests, is never unlawful, disorderly or boisterous and that it does not interfere with the rights, comfort and convenience of other persons on or around the premises.
  7. To control noises including music so that they are not heard in the halls nor outside the dwelling unit.
  8. DESTRUCTION: Do not deliberately nor negligently destroy, deface, damage, abuse, impair or remove a part of the unit, common areas, building, exterior grounds, appliances, fixtures or equipment nor knowingly permit another person to do so. Do not place any kind of grills next to vinyl sided units.
  9. DRAINS: To be responsible for all drains and waste pipes in unit and the cost of clearing or cleaning any partial or complete stoppage occurring during occupancy after the first clearing or cleaning by landlord. DO NOT FLUSH TAMPONS and like items under any circumstances. There is to be no grease dumped down the drain. If this happens, you will be responsible for the cost of cleaning of drains.
  10. EQUIPMENT: To use appliances, fixtures and equipment only for the purposes for which they are intended.
  11. EVICTION: To understand that present written rules may be amended and other written rules may be adopted concerning the tenant's use and occupancy of the premises. Tenant agrees to be bound by such rules and realizes that should he or she break those rules, sufficient ground would exist for the termination of this occupancy.
  12. HEALTH/SAFETY: To comply with requirements of applicable building housing and health codes which materials relate to health and safety and apply to tenants.
  13. LAWN/SNOW: To pull weeds, mow and trim the yard whenever needed to insure a neat appearance. To remove snow and ice from the steps, walks and driveways promptly after snowfall. This applies to all single-family homes and or duplexes that are agreed upon in lease.
  14. LIGHT BULBS: Light bulbs shall be furnished at the time of occupancy. Thereafter, tenant will replace all bulbs at tenant's expense. Upon vacating, tenant will replace all missing bulbs with same watt working bulbs as were originally provided (60 watt.)
  15. LOCKOUT: In the event of a "lockout," each dwelling unit may receive ONE FREE SERVICE call by the Landlord. The charge for any additional service's during regular weekday working hours of 8 a.m. to 5 p.m. will be $10 each. The charge for service calls during evenings, holidays or weekends will be $20.
  16. MALFUNCTIONS: To give landlord prompt notice of any defects in the plumbing, electrical or heating system or in any appliances , fixtures and equipment or any other part of the premises.
  17. PARKING/STORING: To not store nor leave personal belongings in entrance or hallways.
  18. Do not store cars, trailers, boats etc. anyplace on the premises nor in the parking area. Inoperable vehicles are to be repaired or removed within 72 hours. No major car repairs are to be done on the premises. Parking is allowed only in designated parking areas and specifically NOT on the grass. Failure to comply results in the car being towed away at Tenant's expense.
  19. PRIVATE RESIDENCE ONLY: To use as a private residence only for those named as residents and not to conduct any business or acts that are not in keeping with the law or zoning regulations.
  20. RELOCKING: To pay any relocking charges if anytime during tenancy the keys are lost or are not returned at end of occupancy. There will be a minimal charge of $35 for this act.
  22. SUBLET/LOAN: To not sublet nor assign the lease or unit or any part thereof, nor give accommodations to boarders or lodgers. Only those whose names appear on the Rental Agreement may live in the dwelling unit. We will assess a fee of $75.00 per person per month for any unauthorized tenants.
  23. We do not allow more than 2 people per bedroom in any of our units.
  24. UTILITIES: To transfer utilities for which tenant is responsible PRIOR to occupancy.
  25. WINDOWS: To pay for any windows broken negligently or intentionally by tenant or tenant's friends or children.
  26. If living above a business, you must respect the rights of the business. No excessive noise during business hours or lease will be terminated.
  27. If living above a business, park in designated area. Do not park in street or in business' parking lot. Visitors are included.
  28. SMOKING: There is no smoking in the premises. Smoking will be allowed outside only. There will be a charge of $200.00 if there is evidence of smoking in the unit.
  29. NO Pets with out expressed written permission and deposit paid
  30. We do not allow and satellite dish's for cable without expressed written permission, and in most cases we will decline them.
  31. NO Pools or Trampolines on the property.
  32. GIVING NOTICE: Iowa law and common law require that 30 day notice of intention to vacate is to be given no later than the first of the month. Late notice makes tenant responsible for the next month's rent. If we are able to rent quickly with no vacancy we may charge a $75 rerental fee minimum in lieu of a full month's rent.

NOTE: You must scroll to the bottom of the Tenant Rules and Regulations before you can click the above checkbox.

No persons other than those specifically named will be permitted to occupy the dwelling without the written consent of the landlord and an appropriate adjustment in the rent. Acceptance of this application by the landlord shall not constitute a completed agreement to rent the premises. Both parties must also sign a formal written Rental Agreement.

I/We certify that the above information is true and correct to the best of my/our knowledge.
I/We understand that this application will be checked for accuracy and I/We authorize verification of references and a credit check.