(1) Current Address_______________________________Apt#________ City__________________ State______ Zip________
Month/Year Moved In______________________ Reasons for Leaving____________________________Rent $__________
Owner/Agent__________________________________________________Phone ( ) ____________________________

(2) Previous Address_________________________________________________________Rent $____________
Owner/Agent__________________________________________________Phone ( ) ____________________________
(3) Previous Address_________________________________________________________Rent $____________
Owner/Agent__________________________________________________Phone ( ) ____________________________

PLEASE DESCRIBE YOUR CREDIT HISTORY

Have you declared bankruptcy in the past seven (7) years? Yes___________ No____________
Have you ever been evicted from a rental residence? Yes___________ No____________
Have you had two or more late rental payments in the past year? Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due? Yes___________ No____________

PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION

Your Status: _____Full Time _____Part Time _____Student _____Unemployed
Employer______________________________________________________________________________________________
Dates employed_______________________________ Employed as______________________________________________
Supervisor Name______________________________________________ Phone ( )______________________________
Salary $_________________per________________. (If employed by above less than 12 months, give name & phone of previous employer or school:________________________________________________________________________________.)
If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

Amount $___________________ Source/Contact Name________________________________________________________

PLEASE LIST YOUR REFERENCES

Banking Accounts:
Name_________________ Type of Account_________________ Account Number_________________
Name_________________ Type of Account_________________ Account Number_________________

Personal Reference or Emergency Contact:
Name _______________________ Address _______________________________________________Phone _______________________ Relationship_______________________

Driver's License:
Your Driver's License Number_________________ State_________________

Vehicle Information:
Make / Model _________________Year _________________License Plate State_________________

ADDITIONAL INFORMATION:

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

Where may we reach you to discuss this application?

Day Phone # ( ) ___________________________ Night Phone # ( )____________________________

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 above set forth are true; however, should any statement made above be a misrepresentation 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.

The above information, to the best of my knowledge, is true and correct.

Please sign: X__________________________________ __________________________________
Name of Applicant Date
AUTHORIZATION
Release of Information
I agree to permit an investigation of my credit, tenant history, banking and employment for the purposes of renting an apartment with this owner/manager.

_____________________________________________
Name (please print)

X_______________________________________ __________________________
Signature Date
APPLICANT: PLEASE DO NOT WRITE BELOW (FOR OFFICE USE ONLY)

Deposit of $500.00________ Received by ____________________________ Date_______________

OFFICE NOTES: