Fee: $___________
Received By: __________________________
Telephone: __________________________
Address of Property: __________________________
Rental Term: __________________________
Rent Amount: __________________________
(An additional application must be submitted by each occupant who is over 18 and a co-signer.)
Name (First, Middle and Last Name): ____________________________________________
Date of Birth: ____________ Social Security Number (SSN): __________________________
Email: __________________________________________
Cell Phone: _____________________ Work Phone:_____________________
Driver’s License Number: ______________________ State: __________
Do You Have a Vehicle? ☐ Yes ☐ No
If Yes, fill-in below:
License Plate Number: __________________________ State: __________
Make: _____________ Model:___________ Year:_______ Color:_____________
List all additional occupants, including members of the family, who will be living in the house.
Full Name:_________________________ Relationship: ___________________
Full Name:_________________________ Relationship: ___________________
Full Name:_________________________ Relationship: ___________________
Full Name:_________________________ Relationship: ___________________
Present Address
Address:___________________________________________________________
Reason for Leaving: __________________________________________________________
Dates Occupied, From __________to__________ Has Notice been Given?: ☐ Yes ☐ No
Rent Amount: $____________ Security Deposit Amount:$____________
Landlord/Property Manager Name: ________________________________
Landlord/Manager’s Phone: ___________________
Previous Address
Address: __________________________________________________________________
Reason for Leaving: __________________________________________________________
Dates Occupied, From __________to_______ Rent Amount: $____________
Landlord/Property Manager Name: ________________________________
Landlord/Manager’s Phone: ___________________