APPLICANT INFORMATION

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Current Landlord Name

First Name

Last Name

Current Landlord Phone

(###)

###

####

How long have you been at your current address?

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Landlord Name

First Name

Last Name

Previous Landlord Phone

(###)

###

####

Have you ever been served eviction notice or been asked to vacate property you rented?

If yes, when did this happen and explain the circumstances.

Date of Birth

YYYY

Drivers License # / State

Social Security Number

Are you a student?

If Yes, what school are you attending?

Employer

Supervisor's Name

First Name

Last Name

Supervisor's Phone

(###)

###

####

ADDITIONAL INFORMATION

What date are you looking to move in on?

YYYY

Do you use illegal drugs?

Do you engage in the distribution or sale of illegal drugs?

Will children occupy the premises?

If yes, how many children and what ages are they?

Do you have (or will have) pets that you wish to bring onto premises?

Please note, all pets must be approved by landlord. Additional fee's may apply.

If yes, what kind of pet? How many pets? How large are the pets?

Have you ever been convicted of a felony?

If yes, please explain.

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

REFERENCES

Please provide three references

Reference #1 Name

First Name

Last Name

Reference #1 Phone

(###)

###

####

Reference #2 Name

First Name

Last Name

Reference #2 Phone

(###)

###

####

Reference #3 Name

First Name

Last Name

Reference #3 Phone

(###)

###

####

ACKNOWLEDEMENT AND AGREEMENT

Applicant(s) represent(s) that the above statements are true and correct and authorize(s) verification of information, references and credit records. Applicant(s) acknowledge(s) that false information contained herein constitutes grounds for rejection of this application if discovered before move-in and grounds for termination of any resulting lease if discovered after move-in.

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