APPLICATION

1. Name: Married: Yes No
Date of Birth: Present Phone No.: Soc. Sec.: ________________________________________________________________________________________________

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

________________________________________________________________________________________________

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:

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: (REMEMBER TO SIGN THIS AFTER PRINTING)

Manager/Agent: _____________________________ Date:

Rental Agreement Information

Apt #: M.I. Date: Lease Length: