APPLICATION INFORMATION Unit Address:___________________
APPLICANT OR COSIGNER?
Your Date of
Name:_________________________________________________________ Birth:_______________
Spouse’s
Date of
Name:_________________________________________________________ Birth:________________
Your Social Spouse's Social
Security # ____________________________________ Security # ______________________________________
Email Spouse’s Email
Address: ____________________________________ Address: ______________________________________
Phone(s):
H:(_____)____________________ W:(_____)____________________ C:(_____)____________________
Names of People That Will Live With You (If you are a cosigner, please give your relationship to the renter):
Name:_______________________________________ Age:______ Relationship:___________________
Name:_______________________________________ Age:______ Relationship:___________________
Name:_______________________________________ Age:______ Relationship:___________________
Dates Occupied:
Current
From: ___________
Address: _____________________________________________________________
To:____________
City_____________________________________________ State________ Zip___________
Current
Land
lord-Name:______________________________________________ Phone:(______)_______________________
Why Current
Moving?__________________________________________________________________ Rent: $_________________
Dates Occupied:
Previous
From: ___________
Address: _____________________________________________________________
To:____________
City_____________________________________________ State________ Zip___________
Previous
Land
lord-Name:______________________________________________ Phone:(______)_______________________
Why Did Previous
You Move?________________________________________________________________ Rent: $_________________
Employment:
Yours:_________________________________________________ Supervisor:_____________________
City:___________________________________________State______ Phone:(______)__________________________
Monthly How
P
osition:__________________________________________ Income $________________ Long?___
_______________
Spouse:_________________________________________________ Supervisor:______________________
City:___________________________________________State______ Phone:(______)__________________________
Monthly How
P
osition:__________________________________________ Income $________________ Long?__________________
(OVER)
Office Use Only: Rent:__________ Sec. Dep.____________ App. Dep.___________
Other
Income: ____________________ Source:_________________________________________________
____________________________________________________________________________
Type Of
Your Bank:______________________________________ Account:____________________________
Credit Account
Card(s):____________________________________ Number:_________________________________
_____________________________________ Number:_________________________________
Driver's
License # Yours:________________________________ Spouse:_________________________________
Auto Type:_______________________________ Year:___________ License #______________________
IN CASE OF
EMERGENCY, NOTIFY: _________________________________Phone:(____)________________
Address: ________________________________________________________________________________
City:______________________________________________ State:_________ Zip:_____________
DO YOU
HAVE A PET? __________ Type:______________________________________ Weight:_________
DO YOU, OR DOES ANYONE
LIVING WITH YOU, SMOKE A PIPE, CIGARS, OR CIGARETTES? ____________________
DO YOU EXPECT ANY CHANGE
IN FAMILY, JOB, OR INCOME? _____________________________________________________
PURPOSE FOR SEEKING HOUSING IN THIS AREA:
Student at ___________________________
Name of School
Temporary Job Until ___/___/___
New Employment
Permanent Resident
Other: _________________________________________________________________
It is hereby agreed and understood that willfully giving false information on this form is grounds for
immediate eviction. By my signature hereon, I hereby authorize the release of information regarding
my landlord references, employment, banking, and/or credit ratings to Bartlein & Company, Inc. I
understand that a credit report will be obtained from Trans Union Corp., P.O. Box 390, Springfield, PA
19064 Phone: (800) 888-4213 and that I may obtain a copy of my credit information directly from them.
I am requesting
a Lease of: One (1) Year Six (6) Months Other: __________________________
____________________________ ____________________________ Date:_____/_____/_____
Your Signature Spouse’s Signature
© 1994-2019 – All Rights Reserved
Application info.Doc 5/09
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