PERSONAL INFORMATION

Date_________ E-MAIL ADDRESS: _________________ CELL PHONE_______________
Name of Applicant_____________________ Telephone__________________
Are you a student?  ___Yes    ____No
Present Address _________________City _______ State ______ Zip _______
Name of Current Landlord _____________________ Telephone ___________
Residence over past five years: 
Address                Landlord               Landlord Phone No.         Dates
____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Date of Birth _____ Number of tenants?  Adults ______ Children __ Pets_____ 
Kind of pet:  ___ dog  ____ cat ____ other Description: ______________
Employer: ___________ Position _____ How long? _______ Rate of pay ____
Hours worked/week ________ Employer's Telephone ____________________             Supervisor's Name _______________________________________________

HAVE YOU EVER:  Filed for bankruptcy?  ___ Yes ___ No  If "yes", when? ___
Been served an eviction notice or been asked to vacate a property you were renting?   ___ Yes ____ No  Willfully or intentionally refused to pay rent when due?  __ Yes  ___ No  
If "yes", when? ________ How were you referred to us?  __ Newspaper  __ Realtor __ Website __________ Other: Describe _____________________________________
Rental Unit applied for?________________________________________________
Criminal History__________________________________________________
Lease Start date ______________ Term __________ Rent/month ________

I/We declare the foregoing information is true and correct, and I/We hereby authorize you to conduct an employment and credit check and to verify our rental history. 

___________________   ______      ___________________   _______
Applicant's Signature         Date           Co-Applicant's Signature     Date