* Each adult (18 or older) must fill out a separate application
* There is a non-refundable fee of $25/adult to apply, due upon signing lease
First Name* Last Name* BirthDate Cell Phone* Social Security Driver's License
Any Other Names You’ve Used In The Past Home Phone* Email*
All Other Proposed Occupants Birth Date Relationship To Applicant


Current Residence Previous Residence Prior Residence
Street Address
State & Zip
Last Rent Amount Paid
Landlord Phone Number
Reason for leaving
Is/Was rent paid in full?
Were you asked to move?
Name(s) in which your utilities are now billed:
Dates of Residency - Beginning
Dates of Residency - Ending


Current Employer Previous Employer Prior Employer
Employed By
Employer’s Phone
Name of Supervisor
Monthly Gross Pay
Dates of Employment - Start Date
Dates of Employment - End Date


Bank/Institution NameBalance On Deposit or Balance Owed
Savings Account
Checking Account
Credit Card
Auto Loan

VEHICLES (Include vehicles belonging to other proposed occupants also)

MakeModelColorYearLicense Plate


DoctorLawyerNearest 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 can’t locate you. Furthermore, if you abandon the residence for any reason then you grant us permission to allow your relative listed above to remove all contents of the dwelling on your behalf.


Have you ever been served a late rent notice? Do any of the people
who would be living in the residence smoke?
How long
do you think you would be renting from us?
Yes    No Yes    No
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?
Yes    No    Yes    No
Have you ever been served an eviction notice? If so, when? How many pets do you have (list Type, Breed, approx Weight & Age)?
Yes    No   
Have you had any reoccurring problems with your current residence 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 couldn’t come up with the money to pay the rent, do you know someone that would loan you the money? If so, provide the person’s 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 residence?Do you have an e-mail address we can reach you at?
Do you know of anybody else looking for an residence? Please provide their name and number. If you refer a friend and you each end up renting separate residences 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 residence and does not constitute a rental or lease agreement in whole or part. I further understand that there is a non-refundable fee to cover the cost of processing my application and I am not entitled to a refund even if I don’t get the residence. Any questions regarding rejected applications must be submitted in writing and accompanied by a self-addressed stamped envelope.


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