First, Middle, Last Name:
Date of Birth:
Social Security Number:
Driver's License Number:
Other Names Used In the Last 10 Years:
Home Phone:
Work Phone:
Cell Phone:
Additional Occupants-list everyone who will live with you, and their relationship to you:
Employment
Current Employer:
Current Employer Address:
Current Employer Phone:
Job Title with Current Employer:
Name of Supervisor at Current Employer:
Dates of Employment with Current Employer:
Income Per Month with Current Employer:
Prior Employer Name:
Prior Employer Address:
Prior Employer Phone:
Job Title at Prior Employer:
Dates of Employment with Prior Employer:
Income Per Month with Prior Employer:
Current Resdience Address:
Current Residence Dates of Stay:
Current Residence Owner/Manager and Phone Number:
Reason for Leaving:
Last Rent Paid:
Address at Previous Residence #1:
Dates of Stay at Previous Residence #1:
Reason for leaving Previous Residence #1:
Owner/Manager and Phone Number at Previous Residence #1:
Last Rent Paid at Previous Residence #1:
Vehicles
Vehicle #1: Make, Model, Color, Year and License Number
Vehicle #2: Make, Model, Color, Year and License Number
Vehicle #3: Make, Model, Color, Year and License Number
Motorcycles: Make, Model, Color, Year and License Number
Personal References
In Case of Emergency, Notify (include name, address, phone and relationship):
Personal References- Close Friend (include name, address, phone and relationship):
Personal References- Nearest Relative Living Elsewhere(include name, address, phone and relationship):
Credit Information-Please list all your financial obligations below.
Name of Bank or Savings and Loan:
Branch or Address:
Checking Account Number:
Checking Account Balance:
Savings Account Number:
Savings Account Balance:
Credit Account #1 and Account Number:
Credit Account #1 Address and City:
Credit Account #1 Phone:
Credit Account #1 Balance:
Credit Account #1 Due Monthly:
General Information, check all answers that apply:
Do you smoke?
Do you have any pets?
Have you ever filed for bankruptcy?
Do you have any musical instruments?
Do you have, or do you intend to use, any water-filled furniture in the apartment?
Have you ever been convicted of selling, possessing, distributing or manufacturing illegal drugs, or convicted of any other crime?
Have you ever been evicted for non-payment of rent or any other reason?
Please explain any "yes" answers to the above questions:
Why are you leaving your current residence:
Please list address and unit number you are applying to rent/lease:
I understand there is an application fee for the cost of processing this application, to obtain dredit history and other background information.
Applicant represents that all information given on this application is true and correct. Applicant hereby authorizes verification of all references and facts, including but not limited to current and previous landlors and employers, and personal references. Applicant hereby authorizes owner/agent to obtain Unlawful Detainer, Credit Reports, Telechecks, and/or criminal background reports. Applicant agreest to furnish additional credit and/or personal refereneces upon request. Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denail of tenancy. Applicant hereby waives any claim and releases from liability any person or obtaining said verification or additional information.
Applicant Name/Signature:
Date:
