1. Applicant Name __________________________________________Phone______________________________

Present Address:________________________________________________________________________________

How long have you lived there?____________________________  Social Security Number___________________

2. Present Landlord _____________________________________________Phone__________________________

Landlord Address:______________________________________________________________________________

Monthly Rent __________ Reason for Leaving_______________________________________________________

_____________________________________________________________________________________________

3. Previous Landlord _______________________________________________Phone_______________________

Landlord Address:______________________________________________________________________________

Monthly Rent ________________ How long did you live there?__________________________________________

Reason for Leaving_____________________________________________________________________________

_____________________________________________________________________________________________

4. Full names of all individuals (and ages of all children)  who will be occupying premises:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

5. Pets (specify)________________________________________________________________________________

6. Have you ever been evicted, sued for nonpayment of rent, or breached a lease (if so, explain)? 

_____________________________________________________________________________________________

7. Present Employer ________________________________________________Phone______________________

Employer Address______________________________________________________________________________

Occupation:_______________________________________  Title:_______________________________________

Gross Monthly Salary _________________________________ Length of Employment_______________________

8. Previous Employer_______________________________________________Phone_______________________

Employer Address_____________________________________________________________________________­­_

Occupation:______________________________________  Title:________________________________________

Gross Monthly Salary _________________________________ Length of Employment_______________________

9. Other Income, if any (specify source)_____________________________________________ere?_______________________________________________________________________________________

____________________________________________________________________________________________

10. Personal Reference_____________________________________________ Phone _______________________

Reference Address:_____________________________________________________________________________

11. Automobiles:               

Your Driver License Number___________________________________  Issuing State_______________________

(1) Make/Model _______________________  Year _____________  Plate_________________ State____________

(2) Make/Model _______________________  Year _____________  Plate_________________ State____________

18. In case of emergency notify_______________________________ Relationship__________________________

Address:______________________________________________________________________________________

______________________________________________________________Phone:__________________________

I certify that the above information is true and complete.  I authorize the verification of this information by contacting any or all individuals and financial institutions listed above.  I understand that this is not a lease or an offer to rent.  No binding obligation of any kind exists between the owner and myself unless and until a lease is signed.  This Application is subject to prior Applications.  This Application shall remain the property of the owner.

Signature of Applicant__________________________________ Date _____________________

NO PERSON SHALL BE DENIED THE RIGHT TO RENT OUR PROPERTY BECAUSE OF THEIR RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN OR ANCESTRY.