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Fair Housing Act

Please complete the following application as completely as possible and insure the accuracy of information entered to assist us in expediting the application process. Feel free to contact us should you have any questions regarding the completion of this form.

Note that fields with a red asterisk * are required.

 

Tell us who you are you and how to contact you....

Contact Name: *

  
Contact Phone:*
Email: *
      
Tell us about yourself ...

Your Name:
(first & last) 
 

Date of Birth: 
SSN:
  
Present Address:

Driver's License or
Provincial ID #:

  
City,
Issuing State:
  
State
     
Zip
Tell us about your work ...

Present Employer:

 

Occupation:

Supervisor:
 
Supervisor's phone #:

How long?:

 

Employer's Phone:

And your references...
Your bank:
 
Bank address:

Personal references:
(Mother, Father, Sister, Brother, friend, etc)

Credit
references:
(Credit cards, loans, Finance Houses, Utility Co, etc)

Emergency contacts-
Next of kin:
(Wife, Husband, Mother, Father, etc)

Tell us about any other occupants under age 18 . . .

Name:

  
Age:
  Relationship
to Applicant:

Name:

  
Age:
  Relationship
to Applicant:

Name:

  
Age:
  Relationship
to Applicant:

Tell us about your vehicles...

Make/Model:

  
Color:
  License#:

Make/Model:

  
Color:
   License#:
Unlicensed, uninsured or inoperable vehicles are not permitted on our property.
They will be towed at the owner's expense.

By submitting this applcation, the applicant certifies that all statements herein are true and correct and by submitting this form electronically, authorizes the Landlord to contact any references given herein. It is further understood that all information herein remains confidential and will not be released to anyone other than lawful authorities without prior consent of the applicant(s). Applicant(s) understands that no representations, promises or agreements as to occupancy, lease or date of possession have been made. The owners, their representatives or duly authorized agents shall not be liable for any loss or damage occurring due to the inability to deliver possession of the premises applied for. If the applicant withdraws this application, or upon acceptance does not take occupnacy of the premises, all sums deposited will be retained by the owner as liquidated damages and the applicant shall not acquire any right in, or to said premises by reason thereof.

NOTE: I/We, the applicant hereby consent, by submitting this form electronicall, to the landlord or his agent obtaining a credit information report on myself/ourselves from a consumer reporting agency. We authorize the agencies and other persons to disclose information on me/us to the landlord/agent. The landlord/agent has the right to reject this application.

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