APPLICANT'S NAME_______________________________________________________BIRTHDATE___________
SOCIAL SECURITY NO. ________-______-________ MARRIED ___ SINGLE ___ DIVORCED ___ SEPARATED ___
SPOUSE'S NAME_________________________________________________________BIRTHDATE____________
SOCIAL SECURITY NO. ________-______-________ TELEPHONE NO._________________________________
NAMES AND SOCIAL SECURITY NUMBERS OF THOSE UNDER THE AGE OF 18 YEARS.________________________
____________________________ ______________________________ ____________________________
PRESENT ADDRESS______________________________________RENT PER MONTH_______HOW LONG___ ____
LANDLORD'S NAME/ADDRESS___________________________________TELEPHONE NO.___________________
REASON FOR MOVING__________________________________________________________________________
FORMER ADDRESS_______________________________________RENT PER MONTH______ HOW LONG___ ____
LANDLORD'S NAME/ADDRESS___________________________________TELEPHONE NO.____________________
EMPLOYER (Applicant's)______________________________________SUPERVISOR________________________
EMPLOYER'S ADDRESS_________________________________________TELEPHONE NO.___________________
POSITION HELD_________________________HOW LONG____ ____SALARY$___________PER WK. ___ MO. ___ YR. ___
EMPLOYER (Spouse's)________________________________________SUPERVISOR________________________
EMPLOYER'S ADDRESS_________________________________________TELEPHONE NO.___________________
POSITION HELD_________________________HOW LONG____ ____SALARY$___________PER WK. ___ MO. ___ YR. ___
PREVIOUS EMPLOYER__________________________________________________________________________
NAME OF BANK_____________________BRANCH____________________ACCT NO.______________CK. __ SAV. __
CITY_________________________________STATE_____PERSON TO CONTACT___________________________
NAME OF BANK_____________________BRANCH____________________ACCT NO.______________CK. __ SAV. __
CITY_________________________________STATE_____PERSON TO CONTACT___________________________
CREDIT REFERENCES (LOCAL REFERENCES PREFERRED)
1.___________________________________A/C NO.______________________TELEPHONE NO.______________
2.___________________________________A/C NO.______________________TELEPHONE NO.______________
3.___________________________________A/C NO.______________________TELEPHONE NO.______________
PET(S) NUMBER______TYPE(S)_________________WEIGHT(S)_______AGE(S)____HOUSEBROKEN ___ NO ___ YES
VEHICLES-MAKE_______MODEL________YEAR_______COLOR_______LICENSE NO.___________STATE________
VEHICLES-MAKE_______MODEL________YEAR_______COLOR_______LICENSE NO.___________STATE________
DRIVER'S LICENSE NO. (Applicant)___________________________STATE____(Spouse)________STATE_______
CHARACTER REFERENCES
1.________________________________________________________________TELEPHONE NO._____________
2.________________________________________________________________TELEPHONE NO._____________
HAS EITHER APPLICANT, SPOUSE OR ANY OTHER PROPOSED RESIDENT EVER FILED A BANKRUPTCY OR IS EITHER
APPLICANT PRESENTLY INVOLVED IN AN ACTIVE BANKRUPTCY CASE? NO ___ YES ___
IF THE ANSWER TO THE ABOVE WAS YES:
WHERE WAS THE BANKRUPTCY FILED?____________________________________________________________
WHAT WAS THE DATE OF THE BANKRUPTCY?_______________________________________________________
WHO WAS THE ATTORNEY FOR BANKRUPTCY?______________________________________________________
WHAT WAS THE BANKRUPTCY CASE NO.?__________________________________________________________
COMMENTS:__________________________________________________________________________________
____________________________________________________________________________________________
BEEN EVICTED FROM TENANCY? NO ___ YES ___
WILLFULLY OR INTENTIONALLY REFUSED TO PAY RENT WHEN DUE? NO ___ YES ___

HAS EITHER APPLICANT OR ANY PROPOSED OCCUPANT BEEN ARRESTED AND/OR CONVICTED OF ANY

MISDEMEANOR OR FELONY CRIME? THIS QUESTION INCLUDES ARRESTS FOR DUI OR WRECKLESS DRIVING).
NO ___ YES ___ IF YES EXPLAIN:___________________________________________________________________
IN CASE OF ILLNESS, ACCIDENT, EMERGENCY, PLEASE NOTIFY:
NAME_____________________________________________________RELATIONSHIP______________________
ADDRESS__________________________________________________TELEPHONE NO._____________________
Applicant represents that all the statements herein are true and hereby authorizes verification of information, references and credit
Records. Applicant acknowledges that false information herein may constitute grounds for rejection of this application, terminating the
Right of occupancy, and may constitute a criminal offense under the laws of this state.

WITNESS the signatures of the parties hereto this__________________day of__________________________________, 19_____________

_____________________________________________________ _______________________________________________________

Applicant __________________________________ Applicant ___________________________________

THIS APPLICATION IS MADE WITH THE UNDERSTANDING THAT IT IS SUBJECT TO ACCEPTANCE BY THE OWNERS
AND SUBJECT TO EXECUTION BY AN OFFICER OF SAID COMPANY AND DELIVERY OF A LEASE COVERING SAID
PREMISES.

APPROVED ( ) DISAPPROVED ( ) DATE___________________________________TIME_________________

______________________________________
Manager's Signature