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Applicant Information

Last Name

First Name

M.I.

SSN

Driver’s License #

Birth Date

Home Phone

Work Phone

Cell Phone

Current Address

Street Address

City

State

Zip

Date In

Date Out

Landlord Name

Landlord Phone

Monthly Rent

Reason for Leaving

Previous Address

Street Address

City

State

Zip

Date In

Date Out

Landlord Name

Landlord Phone

Monthly Rent

Reason for Leaving

Other Occupants

List names and birth dates of ALL additional occupants 18 years or older

List names and birth dates of ALL dependants 18 years or older

Credit History

Bank Name and Contact

Account Number

Credit Cards / Auto Loans, etc.

Employment & Income Information

1. Occupation

Employer/Company

Montly Salary

Supervisor Name

Supervisor Phone

Start Date

End Date

2. Occupation

Employer/Company

Montly Salary

Supervisor Name

Supervisor Phone

Start Date

End Date

1. Other Income Description

Monthly Income

2. Other Income Description

Monthly Income

Emergency Contact

1. Name

Address

Phone

Relationship

2. Name

Address

Phone

Relationship

Personal References

1. Name

Address

Phone

Relationship

2. Name

Address

Phone

Relationship

Background Information

Have you ever:

Filed for bankruptcy?

Willfully or intentionally refused to pay rent when due?

Been evicted from a tenancy or left owing money? If yes, please provide Property Name, City, State, and Landlord Name

Do you smoke?

Been convicted of a crime? If yes, please provide Type of Offense, County, and State.

Vehicle Information

1. Make & Model

Year

License No. & State

2. Make & Model

Year

License No. & State

Other Vehicles

Other Information

How did you hear about this property?

Please include any other information you believe would help to evaluate this application.

I hereby apply to lease the above described premises for the term and upon the conditions above set forth and agree that the rental is to be payable the 1st day of each month in advance. I warrant that all statements above set forth are true. I hereby give my permission to communicate with my current and former landlord or property manager for the purpose of discussing any and all of the facts and circumstances of my current or former tenancy, as well as the other information listedabove. I also give my permission to communicate with my current employer(s) and/or supervisor(s) for the purpose ofverifying the employment information listed above. I understand there are no limitations or restrictions regarding what may bediscussed or revealed. I am aware that a credit history, eviction search and criminal background check will be done in conjunction with my application. I understand that I may have the right to make a written request within a reasonable periodof time to receive additional, detailed information about the nature and scope of this investigation.

Signed/Applicant

Date

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