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Desired Community

Community Address

Apartment Number

Personal Information

First Name	Last Name	Soc. Sec. #	Date of Birth
Home Phone	Cell Phone	Work Phone	Email

Current Address

Street

City

State

Zip

Community / Landlord Address

Phone #

Move In Date

Move Out Date

Rent Paid

Previous Address

Street

City

State

Zip

Employment Information

Present Employer

Employer Name	City	State	Phone #
Position	Date Hired	Gross Income

Previous Employer

Employer Name	City	State	Phone #
Position	Date Hired	Gross Income

Vehicle Information

Vehicle 1

Make / Year

Vin #

License # / State

Drivers License # / State

Vehicle 2

Make / Year

Vin #

License # / State

Drivers License # / State

Financial Information

Auto Loan

Bank	City / State	State	Loan #
Phone #

Checking Account

Bank	City / State	Branch	Account #
Phone #

Credit Cards

(1) Issuer

(2) Issuer

(3) Issuer

(4) Issuer

Emergency Contact

Name	Street	Apt #	City
State	Zip	Home #	Work #

Additional Information

Please Answer The Following Questions

Do you require any special accomodations?

If so, what type?

Do you own an animal?
Is it a guide dog?	If yes, what type?	Weight	Breed

Have you ever been evicted?

If yes, when?

Do you owe any unpaid rent?

If yes, how much?

Have you ever violated a lease, rental agreement, or regulations at a former place of rent?

Have you ever been charged with a misuse or abuse to any rental property?

Have you ever been convicted of a crime other than a Motor Vehicle Violation?

If yes, please explain?

Release

This is to inform you that as a part o our procedure for processing your application, an investigative consumer may be prepared whereby information is obtained through personal interviews with your landlord, employer, others with whom you are aquainted, a credit check, and a criminal report.

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