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Desired Community

Community Name

Apartment Number

Personal Information

First Name	Middle 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 of 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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