Location: 

Interested Tenant Name: (One adult may complete this application; however all adult 

Mr./Ms.		Mr.Ms.
First		
Init.		
Last		 
Jr/Sr.		-Jr.Sr.II.III.IV.V.

Date of Birth	 
Soc. Sec.	 

Address 1		
Address 2			
City		
State		
Zipcode		
County		

Country		

How long have you been at the above address?   
If less than 2 years, please provide prior address: 

Telephone	
Fax		
E-Mail		
www Site	

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Interested Tenant Employment:

Occupation	

Title		 
Company		

Type Business 	

Address 1		
Address 2			
City		
State		
Zip Code	
County		

Supervisor	
How Long at this business 

Monthly Income Range 

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Rental References:

Lease Reference Name  Relationship  Phone 

Lease Reference Name  Relationship  Phone 

I have filed for bankruptcy in the past 
	Yes
	No
	
I have been evicted in the past 
	Yes
	No
	
I have refused to pay rent in the past 
	Yes
	No
	
I have been late in payment of rent in the past two years 
	Yes
	No
	
I have had an eviction notice served on me in the past 
	Yes
	No
	

I have judgment(s) against me 
	Yes
	No
	
I have been in disputes/litigation with my landlords 
	Yes
	No
	

I currently have a pet or pets 
	Yes
	No
	 Type:  Under 30 pounds? 
	Yes
	No
	

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Where did you find us?
  Who referred you?	


You are required to electronically sign this form
by typing in your name preceded by /s/
e.g. /s/ John Doe

I agree that my Landlord may terminate any agreement entered into in reliance on any misstatement made above. 
Notice: Any credit application fee provided for this application is non-refundable.  References
will not be contacted prior to your request for a lease. 

Print this page for your records.  If we proceed forward, we will require a copy of your
driver's license.