ē††† Each adult (18 or older) must fill out a separate application

ē††† There is a non-refundable fee of $35/adult to apply


First††††††††††††††††††††††††† Middle†††††††††††††††††††††††† Last

Birth Date

Social Security #

Driverís License #





Any Other Names Youíve Used In The Past

Home Phone

Cell Phone




All Other Proposed Occupants

Birth Date

Relationship To Applicant



















Current Residence

Previous Residence

Prior Residence

Street Address








State & Zip




Last Rent Amount Paid








and Phone Number




Reason for leaving




Is/Was rent paid in full?




Did you give notice?




Were you asked to move?




Name(s) in which your utilities are now billed:






Dates of Residency







Current Employment

Previous Employment

Prior Employment

Employed By








Employerís Phone








Name of Supervisor




Monthly Gross Pay








Dates of Employment







Bank/Institution Name

Balance On Deposit or Balance Owed

Savings Account



Checking Account



Credit Card



Auto Loan




VEHICLE (Include vehicles belonging to other proposed occupants also)





License Plate










Nearest Relative Living Elsewhere





Street Address








State & Zip




Phone Number




By signing the application you grant us permission to communicate with all the contacts listed in this section in the event we canít locate you. Furthermore, if you

abandon the apartment for any reason then you grant us permission to allow your relative listed above to remove all contents of the dwelling on your behalf.




Do any of the people

How long

do you think you would be renting from us?


Have you ever been served a late rent notice?



who would be living in the apartment smoke?





Have you ever filed for bankruptcy? If so, when?

When would you be able to move in?

Have you ever been convicted of a felony?




Have you ever been served an eviction notice? If so, when?

How many pets do you have (list Type, Breed, approx Weight & Age)?



Have you had any reoccurring problems with your current apartment or landlord? If yes, please explain:


Why are you moving from your current address?


List any verifiable sources and amounts of income you wish to have considered (optional):


If you were to run into financial difficulty in the future and couldnít come up with the money to pay the rent, do you know someone that would loan you the money? If so, provide the personís name, address, & phone # so that we can use them as a reference for you.


Have you been a party to a lawsuit in the past? If yes, please explain why:


We may run a credit check and a criminal background check. Is there anything negative we will find that you want to comment on?


How did you hear about this apartment?

Do you have an e-mail address we can reach you at?



Do you know of anybody else looking for an apartment? Please provide their name and number. If you refer a friend and you each end up renting separate apartments from us then we will pay you a referral reward.



Agreement & Authorization Signature

I believe that the statements I have made are true and correct. I hereby authorize a credit and/or criminal check to be made, verification of information I provided and communication with any and all names listed on this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for an apartment and does not

constitute a rental or lease agreement in whole or part. I further understand that there is a non-refundable fee of $35 to cover the cost of processing my application and I am not entitled to a refund even if I donít get the apartment. Any questions regarding rejected applications must be submitted in writing and accompanied by a self-addressed stamped envelope.


Signature: ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Date: ††††††††††††††††††††††††††††††††††