Name

First Name

Last Name

Current Address

Phone Number

Date of Birth:

Email Address

SSN:

Co-Applicant Name:

Co-Applicant Date of Birth:

Name of Dependents and Ages:

Other Applicants and their Relationship:

Will you have any pets? If yes, please describe:

Current Address:

City:

State:

Zip Code:

Month / Year Moved In:

Reason for Leaving:

Owner / Agent:

Phone Number:

Previous Address - Last 3 Years:

Rent Amount:

Owner / Agent:

Phone Number:

Have you declared bankruptcy in the past seven (7) years?

Yes

Have you ever been evicted from a rental residence?

Yes

Have you had two or more late rental payments in the last year?

Yes

Have you ever willfully or intentionally refused to pay rent when due?

Yes

Status:

Employer:

Dates Employed:

Supervisor Name:

Phone Number:

Salary:

Totally Monthly Income:

If not employed, do you receive:

DSS

HUD

SNAP

Social Security

Disability

Pension

Other

If yes, to any - how much?

Banking Accounts:

Name:

Account Number:

Type of Account:

Name:

Account Number:

Type of Account:

Personal Reference or Emergency Contact:

Name:

Address:

Phone Number:

Relationship:

Driver's License Number:

State:

Additional Information:

Please give any additional information that might help owner / management evaluate this application?

The below information, to the best of my knowledge, is true and correct:

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application. I warrant that all statements made above set forth are true; however, should any statement made above be a misrepresntation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time and effort in processing my application. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with other with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

Date:

Authorization - Release of Information:

I authorize an investigation of my credit, tenant history, banking and employment for the purpose of renting a house, apartment or condominium from this owner / manager.

Date:

WEST MAIN GARDENS

WEST MAIN GARDENS

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WEST MAIN GARDENS

WEST MAIN GARDENS