APPLICANT Each Applicant over the age of 18 must complete their own application form

First, Middle, Last Name Email Address Social Security # Driver's License #
Other Names Used In The Last 10 Years Home Phone Work Phone Cell Phone

Additional OCCUPANTS List Everyone, who will live with you:

First, Middle, Last Name Relationship To Applicants


Current Employment Prior Employment
Address, City, State
Employer Phone
Job Title
Name of Supervisor
Date of Employment From:To: From: To:
Income Per Month $ $


Current Residence Previous Residence Previous Residence
Street Address
State & Zip
Dates of Stay from to from to from to
Owner/Mgr Name and Phone #
Reason For Leaving
Last Rent Paid $ $ $


Automobiles Make Model Color Year License No.


In Case of Emergency, Notify Address/City Phone Relationship
Close Friend
Nearest Relative Living Elsewhere

CREDIT INFORMATION Please list your all financial obligations

Name of Bank or Savings & Loan Branch or Address Account No. Balance
Checking  $  
Savings  $  
Credit Accounts Account No. Address/City phone Balance Due Monthly

General INFORMATION Choose answer that applies

* Do you smoke? Yes No
* Do you have any pets? Yes No
* Do you have any musical instruments? Yes No
* Do you have any water-filled furniture or do you intended to use water filled furniture in the apartment? Yes No
* Have you ever filed for bankruptcy? Yes No
* Have you ever been convicted for selling, possessing, distributing or manufacturing illegal drugs or convicted of any other crime? Yes No
* Have you ever been evicted for non-payment of rent or any other reason? Yes No

Please explain any "yes" answers to the above questions:

Why are you leaving your current residence?

The Applicant hereby applies to rent/lease Apartment # at for $ per month, and upon owner's approval agrees to enter into a retnal agreement and/or Lease and pay all rent and security deposits required before occupancy.

An application fee of $ is hereby submitted for the cost of processing this application, to obtain credit 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 landlords and employers, and personal references. Applicant hereby authorizes owner/agent to obtain Unlawful Detainer, Credit Reports, Telechecks, and/or criminal background reports. Applicant agrees to furnish additional credit and/or personal references upon request. Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denial of tenancy. Applicant hereby waives any claim and releases from liability any person providing or obtaining said verification or additional information.
Applicant Name: Dated: