Applicant: ____________________________________ SS#: __________________

Spouse's Name: ______________________________ SS#: __________________

Present Address: _____________________________________ Phone #: ________________

City: ________________________ State: ______ Zip code: _____________

Applicant's occupation: _______________ Employer: ____________________

Address: ____________________________ Work phone: ______________ How long? _____

Spouse's occupation: __________________ Employer: _____________________

Address: ____________________________ Work phone: ______________ How long? _____

1) Relationship of applicant(s) (check one)

Husband and wife _____

Single person (s) _____

Other _____

Number of persons in family group: _____ Adults _____ Children

Names and ages of children:

1)_______________________________ 2)_____________________________

3)_______________________________ 4)_____________________________

2) Will any additional persons reside with you? _____ Yes _____ No If yes, how many? _____

Give names, present address, employment and ages of such additional persons:

Name Address Employer Occupation Age

______________________________________________________________________________

______________________________________________________________________________

3) Regarding your present place of residence:

How long have you lived there? ___________________________

Do you rent or own? ____________ If you rent, give the name, address, and phone number of the owner: _______________________________________________________________

If you rent, what are you paying per month? $_______________

4) Number of automobiles owned or used by all occupants: _________________

5) Do you have any pets? _____ Yes _____ No ...describe on reverse side.

7) Maximum monthly rent desired: $____________ Deposit: $_______________

8) Lease period: ____________________________

9) Personal reference (NOT a family member):

__________________________________________________________________________

^{Name Address City, State, Zip Home phone}

10) Personal reference (A family member that will not be living with you):

__________________________________________________________________________

^{Name Address City, State, Zip Home phone}

BY SIGNING THIS APPLICATION, I / WE HEREBY APPROVE AND CONFIRM THE RIGHT OF THE OWNER TO REQUEST A REPORT OF MY / OUR CREDIT HISTORY(IES) AND STANDING(S).

____________________________________ ___________________________________

Applicant Co-Applicant

Date: __________________

For office use only:

Return to: Address: ________________________________

Rent: $__________ Deposit: $__________

Possession Date: _____________________