Names of Person(s) to Occupy Apartment:

1. First Name: Last Name:

Date of Birth: Month: Day: Year: Relationhip:

Phone: - - Email Address:

2. First Name: Last Name:

Date of Birth: Month: Day: Year: Relationhip:

Phone: - - Email Address:

Driver's License No.: #1: #2:

Landlord Information:

Current Address: City: State:

Present Landlord: Phone: How Long: 1 Year Under 1 Year Over 1 Year

Current Rent Paid: $

Previous Address: City: State:

Previous Landlord: Phone: How Long: 1 Year Under 1 Year Over 1 Year

Previous Address: City: State:

Previous Landlord: Phone: How Long: 1 Year Under 1 Year Over 1 Year

Previous Address: City: State:

Previous Landlord: Phone: How Long: 1 Year Under 1 Year Over 1 Year

Empolyment:

Person 1:

Person 2:

Other Income source:

Person 1 Income: $ Person 2 Income: $ Other Income:

Total Income: $

Bank/Credit History:

Bank: Account Type: Checking Savings Checking/ Savings How Long: 1 Year Under 1 Year Over 1 Year

Credit References: 1. 2.

Emergency Information:

Name: Relationship:

Address: City: State:

Zip: Phone:

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Have you been arrested or convicted of a crime in the last 5 years? Yes No

Do you wish to recieve a written explanation of denial? Yes No

The applicant agrees to allow the landlord to do an inquiry with any police authority. The Fair Credit Reporting Act, Public Law 91-508, requires that we notify you that as part of our normal procedure, a routine inquiry may be made. This inquiry will provide applicable information concerning character, general reputation, personal characteristics and mode of living.

To the best of my knowledge, all the above information is true.

All applications are subject to approval of the owner or the managment agment, false, inaccurate or incomplete information may result in the rejection of the application and a foreiture of your application fee.

Digital Signature: A value is required.