Your E-Mail Address ______________________________

                                  Which apartment are you applying for?___________________________ 

 What would your move-in date be?_________________

    A  $25.00 or $40 couple non-refundable application fee is required for investigation.

     A Non- refundable security deposit is required to hold your apartment until you move in – at move-in the security deposit becomes refundable.

 Instructions: Completely fill out each blank and sign where indicated.

APPLICANT_________________________________________SS # ____________________________________

BIRTH DATE: ____________ DRIVERS LICENSE State Issued by ______  #  ______________________________ MARITAL STATUS:  q  Single   q  Married  q Divorced (date) __________   Former Spouse ________________

Spouse  ___________________________________________Spouse SS#______________________________ BIRTH DATE: ___________________ Spouse DRIVERS LICENSE#______________________________________

Present                                                                                              Move/in                                Rent/                     

Address __________________________________ Zip_________ Date____________ ____ Month $__________ 

Present                                                               City

Landlord ___________________________  State/Zip ____________________ Phone (____)______________

Is present rent up to date? q Yes q  No Have you given notice? q Yes q  No   

Have you been asked to leave?    q  Yes       q  No

Previous                                                               City                                                          

Landlord ____________________________  State/Zip ____________________ Phone (____) _____________

Was rent up to date? q  Yes q  No Did you give notice? q Yes q  No Were you asked to leave? q Yes q No

Next Previous                                                           City                          Move/in                           Rent/                   

Address _______________________________State/Zip __________ Move/out___________  Month $_________ 

Next Previous                                                       City

Landlord ______________________________State/Zip_____________________Phone (____) _____________

Was rent up to date? q  Yes q  No Did you give notice?q Yes q  No Were you asked to leave? q Yes q  No

Number to occupy _____________

                                  NAME                                RELATIONSHIP                           BIRTH DATE

PETS:     q  Yes  q No    If yes, give details (number, type & size)______________________________________

CARS

Make/                                           State ________________                                Lien

Model/color #1 ______________ License Plate #1 ____________________ Holder #1   ___________________

Make/                                          State ________________                          Lien

Model/color #2 _____________ License Plate #2 ____________________Holder #2   ________________ 

 EMPLOYMENT                                        Employed             PREVIOUS                                        Dates of

EMPLOYER ________________________Since_______ EMPLOYER ___________________Employment________

                                                                Hrs/Wk                                                                           Hrs/Wk

What do you do? __________________Worked________What did you do? _______________Worked__________

Supervisor _________________Phone (___) __________ Supervisor _____________ Phone (___)_______________________________________________________________________________________________________  Spouse                                                     Employed            PREVIOUS                                          Dates of

INCOME 

Current Income  $______________   Weekly/Biweekly/Monthly/Yearly      Source__________________________

Current Income  $______________   Weekly/Biweekly/Monthly/Yearly      Source__________________________

Current Income  $______________   Weekly/Biweekly/Monthly/Yearly      Source__________________________

Bank/Credit Union $__________________________             Bank/Credit Union $___________________________

Relative _________________Phone (____) _________  Reference _________________Phone (____)________

Address _________________­____________________ Address    ______________________________________

Non-Relative                                                                               Emergency

Reference ___________________Phone (____) __________ Contact ______________Phone (____) _________

Address _________________­____________________ Address    ______________________________________

Explain any "YES" answers on back with names and details.

Has any signer ever been sued for bills? qYes q  No   Has any signer ever been sued for eviction? q Yesq  No

Has any signer ever been bankrupt?  q Yes  q  No       Has any signer ever been guilty of a felony? q Yes q No

Has any signer ever broken a lease? qYes q No 

 Is the total move-in amount available now (rent and deposit)? q Yesq No

 Do you own a vacuum cleaner? q  Yes  q  No   Do you own a lawn mower?            q  Yes  q  No

Name in which utilities are now billed __________________________________________

Applicant authorizes the owner to contact past and present landlords, employers, creditors, credit bureau, neighbors and any other sources deemed necessary to investigate applicant.

All the information is true, accurate and complete to the best of applicant's knowledge.  Owner reserves the right to disqualify tenant if information is not as represented.

 ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM

X____________________________________________________            __________________

  APPLICANT                                                                                                 DATE

X____________________________________________________            __________________

PROPERTY TYPE Apartments Houses Office Space Warehouse   PREFERENCES   Features Pets OK Pool W/D Beds Any 1 2 3 4 5 6+ Baths Any 1 2 3 4 5 +