2215 W 105th St

Name

Email

Phone

Date Of Birth

SSN

Driver's License No.

Other occupants?( Yes/No)

If Yes, describe:

Pets? (Yes/No)

If Yes, describe:

Vehicles? (Yes/No)

If Yes, describe:

Ever been convicted of a crime? (Yes / No) 

If Yes, describe:

Ever filed for Bankruptcy? (Yes / No) 

If Yes, describe:

Ever been evicted (Yes/No)?

If Yes, describe:

CURRENT EMPLOYMENT 

Company:

Occupation/Title:

Work Phone:

How Long have been in this company?

Gross Income: (From Prior Year Tax Filing)

Company Address:

Supervisor's Full Name:

Supervisor's Phone:

PREVIOUS EMPLOYMENT 

Company:

Occupation/Title:

Work Phone:

How Long have been in this company?

Gross Income: (From Prior Year Tax Filing)

Company Address:

Supervisor's Full Name:

Supervisor's Phone:

CURRENT RESIDENCE

Type:

Area in square feet:

No. of Bedrooms:

Rent Amount ($/month):

Street Address:

City:

State:

Zip:

How long at this address? 

Current Lease Expiration Date:

Desire for Moving?

CURRENT LANDLORD

Name:

Address:

Phone:

E-Mail:

PREVIOUS RESIDENCE

Type:

Area in Square Feet

No. of Bedrooms:

Rent Amount ($/month)

Street Address:

City:

State:

Zip:

Start Date:

End Date:

PREVIOUS LANDLORD

Name:

Address:

Phone:

E-Mail:

PERSONAL REFERENCES

Please input at least one reference

Full Name:

Relationship:

E-Mail:

Phone:

Full Name:

Relationship:

Email:

Phone:

ADDITIONAL DETAILS (If any)

I am applying for:

I hereby certify that I am at least 18 years of age. Applicant represents that all information given on this application is true and correct. Applicant hereby authorizes verification of all references and facts, including but not limited to current and previous landlords, employers, and personal references. Applicant hereby authorizes owner/agent to obtain any and all Unlawful Detainer, Credit Reports, Telechecks, and/or Criminal Background Reports. Applicant agrees to furnish additional credit and/or personal references upon request. Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denial of tenancy. Applicant hereby waives any claim and releases from liability any person providing or obtaining said verification or additional information.