1. Name: _____________________________________________________ Married: _____ Single: ____
Date of Birth: _______________ Present Phone No.: ______________________ Soc. Sec.: ___________

2. Information about other occupants (Separate application required for all adults except spouse):

A. ____________________________________________________________________________________
B. ____________________________________________________________________________________
C. ____________________________________________________________________________________

3. Will pet or assistive animal of any type live in your apartment? Yes: __ No: __ If yes, please describe:
Type: __________________ Weight: ___________ Spayed/Neutered: ________ Licensed/Date: ________

4. Resident Information
Current Residence: Address: ______________________________ Apt No.: ________ City/State: ______
Zip Code: ___________
How long: ___ Years ____ Mos. Name of Landlord: _________________ Landlord Phone: ____________

5. Employed by: ___________________________________ Address: ______________________________
Phone: _________________ Position: _______________________ How long: _____ Years ____Mos.
Supervisor’s name: ________________ Phone number: ___________ Your monthly income: _______
Other source of income for rental payment: ___________________________________________________

6. Spouse or other occupant’s name: ____________________________ DOB: _________ SS#: ________
(Maiden Name If Married Less Than Two Years)
Employed By: ________________________ Address: __________________________________________
Phone: ___________________ Position: ______________________ How long: _____ Years ___ Mos.
Supervisor’s name: ____________________ Phone number: __________ Your monthly income: _____

7. Vehicle information:

Auto: _________________________________________________________________________________
Auto: _________________________________________________________________________________
Motorcycle: ____________________________________________________________________________
Other vehicle: Make/Model:___________ Year: ____ Color: _____ License Plate No.:_______ State: _______

8. Have you or your spouse/roommate ever been evicted: _ Yes _No Declared bankruptcy: _ Yes _ No
Do you use illegal drugs: _Yes _No Do you engage in the distribution or sale of illegal drugs: _ Yes _No
Have you ever been convicted of a felony: __ Yes __ No If yes, please explain the reason: _____________
______________________________________________________________________________________

9. Do you have a waterbed: ___ Yes __ No Do you have a waterbed insurance ___ Yes ___ No

10. Person(s) to notify and person you authorize to take possession of your personal property in Case of
Emergency:

Note: Management is not responsible for damage to residents’ property unless caused by
negligence on the part of management or an employee of management. Residents are
strongly advised to obtain renters insurance to cover loss or damage to their property!

_______________________________________________________________________________________

Applicants represent that all of the above statements are true and complete, and hereby
authorize verification of above information, references and credit records. Applicant
acknowledges that false information, contained herein constitutes grounds for rejection
of this application. Applicant acknowledges that management may not be able to
complete a comprehensive evaluation of this Agreement before move-in. Management
reserves the right to verify application information after move-in and may convert the
proposed Rental Agreement to month-to-month term if false or misleading information
is contained in this Application. Applicant agrees to the terms of the “Deposit To Hold
Agreement”. This application is preliminary only and does not obligate owner or owner’s
representative to execute a lease or deliver possession of the proposed premises.

Applicant’s Signature: _________________________ Date: ____________
Manager/Agent: ______________________________ Date: ____________

Rental Agreement Information

Apt #: __________ M.I. Date: ______________ Lease Length: ____________