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Monthly Rent: Lease Term: Security deposit:

Household information: Each adult applicant must complete a separate application.

Complete the following information for each household member that will occupy the unit at the time of move-in and throughout the lease.
APPLICATION MUST BE COMPLETED IN FULL. FALSIFICATION OF INFORMATION IS GROUNDS FOR DENIAL.

Household member #1:
First Name: Middle Initial: Last Name:

Male Female

Social Security Number

Birthdate: Month/Day/Year / /

Household member #2:
First Name: Middle Initial: Last Name:

Male Female

Social Security Number

Birthdate: Month/Day/Year / /

Household member #3:
First Name: Middle Initial: Last Name:

Male Female

Social Security Number

Birthdate: Month/Day/Year / /

WHERE CAN YOU BE REACHED?
Daytime phone #: Evening Phone #:

1. Do you expect any additions to the household within the next 12 months?
Yes No
Name & Relationship:

2. Have you, or any other person named on this application, ever been convicted of a crime?
Yes No
Explanation:

3. Do you have or do you anticipate having any pets?
Yes No
Explanation:

Applicant's Rental History

Have you ever refused to pay rent?
Yes No

Been evicted or asked to leave?
Yes No

1. CURRENT ADDRESS

Rent: From: To:

Landlord's Name:

Address:

Phone #: Fax #:

2. PREVIOUS ADDRESS

Rent: From: To:

Landlord's Name:

Address:

Phone #: Fax #:

3. PREVIOUS ADDRESS

Rent: From: To:

Landlord's Name:

Address:

Phone #: Fax #:

Emergency Contact

Name and Relationship:

Address:

Phone #:

Vehicle Information

Car # 1:
Make Model Yr Color:

Plate #: Driver's License #:

Car # 2:
Make Model Yr Color:

Plate #: Driver's License #:

Applicant's Income / Credit: Please include all sources of income you would like considered in this application.

Place of Employment: Address:

How many hours per week? Gross Monthly Income

How long have you been employed here?

Give Dates) From: To: Supervisor's Name:

Phone #:

Place of Employment: Address:

How many hours per week? Gross Monthly Income

How long have you been employed here?

Give Dates) From: To: Supervisor's Name:

Phone #:

Applicant's Credit References

Have you ever filed for bankruptcy? Yes No

Address:

Phone #:

Type:

Account Number:

Address:

Phone #:

Type:

Account Number:

Other Sources of Income

Will you be receiving any other income that you want considered with this application (e.g., Section 8 Rental Assistance, SSI, Social Security, public assistance, W-2, alimony, child support, savings, trust funds, scholarships, or any other type of income)? If so, please provide the following information for verification.

Source of Income (Name of Agency):

Address of Agency:

Contact Person's Name: Phone #:

Source of Income (Name of Agency):

Address of Agency:

Contact Person's Name: Phone #:

Self Employed Applicants: If you are self employed you will need to provide the following information: Tax returns, business license, bank records and/or vendor names, with addresses and phone numbers for verification.

Signature Clause

The purpose of this application is to determine whether I qualify as a tenant. If my application is approved, the Landlord and I shall sign a written lease. I have no rental agreement with the Landlord before the time of the lease signing.

I hereby authorize the Landlord and Manager to investigate my credit and financial responsibility, income, rental and eviction history, and the statements made in this application, and to obtain a consumer credit report on me from a consumer reporting agency that complies and maintains files on consumers on a nationwide basis. My performance under any lease or rental agreement that I may enter into with the Landlord may be reported to such reporting agency.

I acknowledge that the Manager and the agents and employees thereof represent the interests of the Landlord, but they also have a duty to treat all parties fairly and in accordance with fair housing law, and to disclose material adverse facts about the property.

I warrant and represent that I am at least 18 years of age and that all information and answers to the above questions are true and complete to the best of my knowledge. I understand that providing false information or making false statements may be grounds for denial of my application. I also understand that such action may result in criminal penalties. I understand that my occupancy is contingent on meeting management's resident selection criteria.

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