RESIDENCY APPLICATION & INFORMATION
Name of Applicant: Phone: ( )______
S.S. Number: ( )– ( ) – ( ) Date of Birth: / /______
Drivers License # State:______
E-Mail:______
Co- Applicant: Phone: ( )______
S.S. Number: ( )– ( ) – ( ) Date of Birth: / /______
Drivers License # State:______
E-Mail:______
Other Occupants:
Name:______Date of Birth: / / __Relationship:______
Name:______Date of Birth: / / __Relationship:______
Name:______Date of Birth: / / __Relationship:______
Applicant EMPLOYMENT INFORMATION:
Present Employer (applicant):______Occupation/Title:______
Employer’s Address: Street:______
City:______State: Zip:______
Employer’s Phone: ( )______Monthly Income:______
Length of employment:______
Previous Employer (applicant):______Occupation/Title:______
Employer’s Address: Street:______
City:______State: Zip:______
Employer’s Phone: ( )______Monthly Income:______
Present Employer: (Co-Applicant):______Occupation/Title:______
Employer’s Address: Street:______
City:______State: Zip:______
Employer’s Phone: ( )______Monthly Income:______
ADDITION INCOME INFORMATION
Source of Additional Income:______Monthly Amount:______
RESIDENCY INFORMATION
Apply for: □ 2 bedrooms or □ 3 bedrooms
Move in date: ______
Current Street Address:
City: State: Zip Code:
Monthly Rent: $ Deposit Paid: $ Lease Start Date: Lease End Date:
Landlord Name: Phone:______
Previous Street Address:
City: State: Zip Code:
Monthly Rent: $ Deposit Paid: $ Lease Start Date: Lease End Date:
Landlord Name: Phone: _
Has anyone listed on this application ever been evicted, broken a lease contract or been sued for damages or non-payment of rent? □ Yes □ No
Explain ______
VEHICLE INFORMATION
Make: Model: Year: License No.
Make: Model: Year: License No.
Make: Model: Year: License No.
PET INFORMATION
Breed: Age: Weight: Vaccines:
Breed: Age: Weight: Vaccines:
BANK AND CREDIT REFERENCES:
Bank Name: City: State: ______
Credit Card: City: State: ______
PERSONAL REFERENCE:
Name: Phone: Relationship:
CRIMINAL BACKGROUND
1. Have anyone listed on this application ever been convicted of or plead guilty or “no contest” to a felony (whether or not resulting in a conviction)? ? Yes ? No
2. Have anyone listed on this application ever been convicted of or plead guilty or “no contest” to a misdemeanor involving violence or sexual misconduct
(Whether or not resulting in conviction)? ? Yes ? No
EMERGENCY CONTACT INFORMATION:
In case of emergency, Notify: Relationship: ______
Phone#: (__) ______E-Mail:______
Acknowledgment
I certify all of the above information is true and complete. I authorize Management to use reasonable and necessary means to verify any of the above and
procure such other information which may be required to evaluate this application, including, but not limited to an investigation of my credit, criminal
background, employment history and previous rental history.
Signature of Applicant: Date:______
“Equal Housing Opportunity”
OFFICE USE ONLY
Income Percentage: Size of Unit Desired:
Landlord Verification: Unit Number Shown:
Phone I.D. Obtained: Move-In Date: