Fields in RED are required entries

1. Rental Property

   1. Address

2. Applicant

   1. Name:		SSN:		Birth Date:
      Email Address:
      Telephone:

      Present Address

      1. Street:
         City:	State: Zip:

      2. How long at address? Monthly Rent:
      3. Owner / Manager: Phone:
      4. Reason for Move:
      5. Any Pets? ?? NO YES Describe:
      Previous Address (if at current address less than 2 years)

      1. Street:
         City:	State: Zip:

      2. How long at address?
3. Employment

   1. Employer:		Phone:
      Occupation:		How Long?
      Salary:		Per Hour Per Week Per Month Per Year
      From:	To:

      If you have a second job.

      Employer:		Phone:
      Occupation:		How Long?
      Salary:		Per Hour Per Week Per Month Per Year
      From:	To:

4. Banking Information

   Bank Name:

   Account #:

5. Have You Ever...

   1. Filed for bankruptcy?	?? NO YES
      Been Evicted? (Will be checked)	?? NO YES
      In the event that you do not qualify, do you have a cosigner that owns a home?	?? NO YES
      Been convicted of a felony?	?? NO YES

6. Personal References / Emergency Contact

   1. Name:   Phone:   Emergency: NO YES
   2. Name:   Phone:   Emergency: NO YES
   3. Name:   Phone:   Emergency: NO YES
   4. Name:   Phone:   Emergency: NO YES
   5. Name:   Phone:   Emergency: NO YES

7. 	I declare that the statements above are true and correct. I authorize verification of my references and credit as they relate to my tenancy and to future rent collections. I give permission to contact previous landlord. Application fee required to process.
   $250(min.) deposit is required to hold property. If potential tenant decides not to rent property or falsifies information, all deposit monies will be retained by Landlord as liquidated damages.