First Name *

Last Name *

Middle Initial

SSI# (xxx-xx-xxxx) *

First Name

Last Name

Middle Initial

SSI# (xxx-xx-xxxx)

Street Address *

City *

State *
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ZIP *

Home Phone *

Work Phone

Fax

Email

Persons to Reside in Apartment

Name

Occupation

Relation to Applicant

Date of Birth

SSI# (xxx-xx-xxxx)

Name

Occupation

Relation to Applicant

Date of Birth

SSI# (xxx-xx-xxxx)

Name

Occupation

Relation to Applicant

Date of Birth

SSI# (xxx-xx-xxxx)

Name

Occupation

Relation to Applicant

Date of Birth

SSI# (xxx-xx-xxxx)

Residency History

How Long at Current Address?

Own, Rent, Other (explain)

Name

Address

Phone

Moved In

Moved Out (planned)

Name

Address

Phone

Moved In

Moved Out

Name

Address

Phone

Moved In

Moved Out

Pet Information

Do you Own a Pet?

If yes, Type of Pet and Weight

Is it a Guide or Support Animal?

Employment/Income Information

Employer

Employer Address

Employer Phone

Position

Monthly Income

Years on Job

Supervisors Name

Employer

Employer Address

Employer Phone

Position

Monthly Income

Years on Job

Supervisors Name

Employer

Employer Address

Employer Phone

Position

Monthly Income

Years on Job

Supervisors Name

Other Income You Would Like Considered

Current Liabilities

Creditor Name

Account#

Amount Owed

# of Payments Left

Monthly Amount

Creditor Name

Account#

Amount Owed

# of Payments Left

Monthly Amount

Creditor Name

Account#

Amount Owed

# of Payments Left

Monthly Amount

Creditor Name

Account#

Amount Owed

# of Payments Left

Monthly Amount

Creditor Name

Account#

Amount Owed

# of Payments Left

Monthly Amount

Personal References

Name

Address

City

Telephone

Name

Address

City

Telephone

Bank References

Name

Address

City

Telephone

Name

Address

City

Telephone

Other Information

No Yes

If yes, explain below:

An application deposit in the amount of $500 is required to hold an apartment. This fee is not a security deposit; however, once the lease is signed it shall become the security deposit for your unit. The application deposit shall only be refunded in the event that you are not approved for residency. Should you withdraw your application after you are approved, we may keep the application deposit as liquidated damages and terminate all further obligations under this Agreement.

The sum of $35 is hereby paid to cover the cost and expense of obtaining a credit report on the applicant(s); the sum is not refundable. Applicant(s) understand that the filing of this application does not bind the Lessor to reserve or assign an apartment.

The undersigned applicant(s) has examined the statements made in this application and hereby certify that they are true, correct and complete and that all household income has been listed above. The statements are made to induce the Lessor to enter into a lease with Applicant(s) for the apartment listed above.

I/We agree that inquiries may be made to verify the statements made in this application.