Application

PERSONAL INFORMATION

First Name *

Middle Name *

Last Name *

S.S # *

Date of Birth *

Status *

Driver's License # *

License State *

Phone Type *

Phone Number *

Email *

Present Home Address *

Present Home Address

Address 1

Address 2

City

State

Zip

Length of Time *

Present Landlord *

Landlord Phone *

Reason for Leaving *

Amount of Rent *

Is Your Present Rent Up to Date? *

Previous Home Address

Address 1

Address 2

City

State

Zip

Length of Time

Previous Landlord

Landlord Phone

Reason for Leaving

Amount of Rent

Was Your Previous Rent Up to Date?

PROPOSED OCCUPANT(S)

Every occupant must be listed on each application. Every occupant over 18 must fill out their own application.

Name

Relationship

Occupation

Age

PROPOSED PET(S)

Pet fees and restrictions will apply

If pet is approved, do you agree to a monthy fee? *

Name

Type/Breed

Indoor/Outdoor

Weight

Name

Type/Breed

Indoor/Outdoor

Weight

Name

Type/Breed

Indoor/Outdoor

Weight

VEHICLE(S) INFORMATION

Year

Make

Model

Color

Plate #

State

Year

Make

Model

Color

Plate #

State

EMPLOYMENT

Current Employer *

Occupation *

Hours per Week *

Address *

Address

Address 1

Address 2

City

State

Zip

Previous Employer

Occupation

Hours per Week

Address

Address 1

Address 2

City

State

Zip

RENTAL ASSISTANCE

Rental Assistance/Subsid Type

Voucher Amount

Expiration Date

Case Number

Case Worker Name

Case Worker phone #

INCOME SOURCES

Please list as many as possible

Income Amount *

Frequency *

Source *

Other *

Proof of Income *

Income Amount

Frequency

Source

Other

Proof of Income

CREDIT CARD / FINANCIAL INFORMATION

Car Loan/Lien Holder

Due Monthly

Phone Number

Address

Credit Card Company

Due Monthly

Phone Number

Address

Credit Reference

Due Monthly

Phone Number

Address

Credit Reference

Due Monthly

Phone Number

Address

Name of Bank

Due Monthly

Phone Number

Address

EMERGENCY CONTACT

Name *

Phone Type *

Phone Number *

Relation *

PERSONAL REFERENCE

Name *

Phone Type *

Phone Number *

Relation *

APPLICATION QUESTIONNAIRE/AUTHORIZATION

Has applicant ever been sued for bills? *

Yes

No

Has applicant ever been locked out of their apartment by the sheriff? *

Yes

No

Has applicant ever been bankrupt? *

Yes

No

Has applicant ever been brought to court by another landlord? *

Yes

No

Has applicant ever been guilty of a felony? *

Yes

No

Has applicant ever moved owing rent or damaged an apartment? *

Yes

No

Has applicant ever been arrested or charged for drug possession or sale? *

Yes

No

Is the total move-in amount available now (rent and deposit)? *

Yes

No

Have you been evicted from prior residence? *

Yes

No

Do you use tobacco or electronic smoking devices? *

Yes

No

How were you referred to us? *

Newspaper

Craigs List

Realtor

Other

Other *

Applicant authorizes the landlord to contact past and present landlords, employers, creditors, credit bureaus, neighbors and any other sources deemed necessary to investigate applicant. All information is true, accurate and complete to the best of applicant’s knowledge. Landlord reserves the right to disqualify tenant if information is not as represented.

ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME.  If you have any questions about the interpretation or legality of this form, please consult an attorney or other qualified Person.

Applicant Signature *

Date *

agreement *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.