Current Address (City, State & Zip)_____________________________________________________________________________

Social Security Number__________________________________Home Phone (          )____________________________________

Cell Phone (         )______________________________________Day Time Phone (         )__________________________________

E mail___________________________________________________________________________________________________

Date of Birth_________________Sex______Driver's License Number___________________________State__________________

Marital Status:_______Single______Married______Divorced______Seperated_____Widowed

If leasing, current property owner/manager and phone number_______________________________________________________

Present Employer________________________________________Phone(         )________________________Ext_____________

Employers Address_________________________________________________________________________________________

Spouse's Full Name____________________________________Date of Birth__________________________Sex_____________

Social Security Number_____________________________Driver's License Number & State_______________________________

Spouse's Employer______________________________________Phone(         )_________________________Ext_____________

Employers Address_________________________________________________________________________________________

What is your relationship to the resident?______Parent _______Brother/Sister _______Employer _______Other

Have you or your spouse ever (check one, if yes please explain)

Been evicted or asked to move out?_______No _______Yes_________________________________________________________

Broken a rental agreement or lease contract?________No _______Yes________________________________________________

Declared Bankruptcy?______No ______Yes Month/Year___________________________________________________________

Been sued for nonpayment of rent?______No _____Yes____________________________________________________________

Been sued for damage to rental property?______No_____Yes_______________________________________________________
 

Failure to answer any of the above or changes, falsification of information
listed herein entitles Landlord to reject this application.

The first page must be notarized to be valid.
A facsimile of this document will be just as binding as an original.