Name:________________________Social Security #:________________Date of birth:_____________
Address:______________City:________State:_____ZIP:_______Phone #:___________
How long at current address?________Current Landlord:__________________Phone #:____________
Why are you moving?__________________________________________________________________
Previous address:_______________City:____________State:_____ZIP:_______How long?__________

Drivers License #:_________________Type of car:__________color:_________License #:__________

Employer:_______________________Address:_____________________Phone #:_________________
Position:____________________How long?_____Supervisor__________________Phone #:_________
Monthly Gross Income:____________ Other sources of income:_____________Monthly amount:_____
Previous employer:____________________________How long:________Phone #:________________

Pets?_____     Cats are NOT ALLOWED! Dogs permitted ONLY with written approval from Landlord.
                              Unauthorized pets are grounds for immediate eviction.

Smoker?___Drinker?__Ever evicted?___Ever filed bankruptcy?___Ever refused to pay rent?________
Do you know of anything which may interrupt your income or your ability to pay rent on time?______

Emergency
contact:___________________________Relationship:____________________Phone #:_____________

Credit
reference:_________________________Address:_______________________Phone #:_____________

Personal
reference:_________________________Address:________________________Phone #:____________

Nearest
relative:__________________________Address:________________________Phone #:____________


Other Tenants
 Name______________________________Age_________Relationship___________Occupation_______

___________________________________________________________________________________


Landlord will not discriminate against applicants or tenants on the basis of race, sex, religion, national origin or age.

Applicants authorize and agree to a credit report to be performed.

Applicants authorize and agree that we may contact their former/current Landlord.

I hereby certify that the answers I have given in this application are true and correct to the best of my knowledge.  I understand that any false answers or statements made by me will be sufficient grounds for immediate eviction and loss of any security deposit. ACCEPTANCE OF DEPOSIT AND RENTAL AGREEMENT DEPENDENT UPON VERIFICATION OF ABOVE STATEMENTS.  IF DEPOSIT/SURETY IS HELD FOR AN
ANTICIPATED TENANT FOR AN APARTMENT AND THE PROCEDURES TO RENT THE APARTMENT ARE
HALTED BY ANTICIPATED TENANT, THE FULL DEPOSIT/SURETY WILL BE FORFEITED.

signed:____________________________________________________________date:___________