Co-applicant's first name		Last name		Phone number
Drivers license # & State		Social security #		Birthdate	(YYMMDD)
Children or other occupants names & ages.
E-Mail address(es) where you prefer to be contacted:

RESIDENCE HISTORY

Present Address:	City:	State:	Zip:
How long?	Phone number	Own	Rent
Name and address of present landlord	Landlord's phone #	Monthly Rent $
Previous Address:	Prev City:	Prev State:	Prev Zip:
How long at previous address?	Prev Phone number	Own	Rent
Name and address of previous landlord	Prev Landlord's phone #	Previous Monthly Rent $

EMPLOYMENT HISTORY

Applicant employed by:	Supervisor:	How long?:
Applicant's Employer's Address:	Position:	Monthly Pay: $
Applicant's Previous employer:	Previous Supervisor:	How long with prior employer?:
Applicant's Previous Employer's Address:	Previous Position:	Previous Monthly Pay: $
Co-Applicant employed by:	Supervisor:	How long?:
Co-Applicant's Employer's Address:	Position:	Monthly Pay: $
Other Income

VEHICLE INFORMATION

Vehicle 1: Make and Model	License #	Color	State
Financed/Leased thru	Phone	Account #	Monthly payment $
Vehicle 2: Make and Model	License #	Color	State
Financed/Leased thru	Phone	Account #	Monthly payment $

PERSONAL REFERENCES

Name 1:	Phone 1:	Name 2:	Phone 2:
Name 3:	Phone 3:	Name 4 (Optional):	Phone 4:
Family Name:	Phone:	Relationship:
Cotenant Family:	Phone:	Relationship:

CONTACTS
Emergency contact	Relationship	Emergency phone	Night phone
.
Have you ever filed for bankruptcy? No Yes	Have you ever been evicted from any tenancy? No Yes	Have you ever been convicted of a criminal offense? No Yes	Does anyone in your household smoke? No Yes
.
I DECLARE THE FOREGOING TO BE TRUE UNDER THE PENALTY OF PERJURY. I authorize you to verify any reference. By submitting below, I represent that the contents herein are true and correct. I consent to the landlord contacting any of my past and present employers, superiors, references, landlords or any referral service operated for landlords. I consent to the landlord obtaining a credit report on me or any other tenant, named herein. I further understand and agree that the landlord may release information regarding my tenancy and desirability as a tenant to any referral service operated by other landlords or to other landlords, and I agree to idemnify and hold harmless the landlord from any and all claims in any way related to the release of the information. Applicant__________________________________ Co-Applicant__________________________________ Print a HARD COPY of this page