APARTMENT APPLICATION FORM

This form shall be construed as a rental application and offered to:

_____________________________________________________ (Landlord/R.E. name)

for unit # _______ at ____________________________________ (street address)

_____________________________________________________ (city, state & zip)

This application includes a deposit in the amount of $_____________

to be used towards the first month's rent upon acceptance of this offer to rent.

Rent per month is $_______ Term of lease: _____________ (months) _______ (days)

Lease to start: _____________________ and terminate on: _____________________

Additional monies due upon acceptance of this application by the landlord include:

First month's rent: $_______ Last month's rent: $_______ Security deposit: $_______

Key deposit: $_______ Parking deposit: $_______ Other: $_______

The following utilities are due in addition to the rent: _____________________________

Name:______________________________________ Social Security #: ___________

Current Address:

Street: ______________________________________________________ Apt #: ____

City: ______________________________________ State: ___________ Zip: _______

Phone: Day: _________________ Eve: __________________ Cell: ________________

Email Address: ______________________ Website: ____________________________

Current Landlord: _______________________________________________________

Street: _____________________________________________________ Suite #: ____

City: ______________________________________ State: ___________ Zip: _______

Phone: Day: _________________ Eve: __________________ Cell: ________________

Email Address: ______________________ Website: ____________________________

Previous Address:

Street: ______________________________________________________ Apt #: ____

City: ______________________________________ State: ___________ Zip: _______

Previous Landlord: _______________________________________________________

Street: _____________________________________________________ Suite #: ____

City: ______________________________________ State: ___________ Zip: _______

Phone: Day: _________________ Eve: __________________ Cell: ________________

Email Address: ______________________ Website: _____________________________

Previous Address:

Street: _______________________________________________________ Apt #: ____

City: ______________________________________ State: ___________ Zip: _______

Previous Landlord:

Street: _____________________________________________________ Suite #: ____

City: ______________________________________ State: ___________ Zip: _______

Phone: Day: _________________ Eve: __________________ Cell: ________________

Email Address: ______________________ Website: _____________________________

Current Employer: __________________________Current job:_____________________

Name of Company Contact: ________________________ Title: _________________

Street: _____________________________________________________ Suite #: ____

City: ______________________________________ State: ___________ Zip: _______

Phone: _________________ Fax: _______________ Email Address: _______________

Website: _____________________________

Previous Employer: ________________________ Previous job: _____________________

Name of Company Contact: ________________________Title: _____________________

Street: _____________________________________________________ Suite #: ____

City: ______________________________________ State: ___________ Zip: _______

Phone: _________________ Fax: _______________ Email Address: _______________

Website: _____________________________

Credit References

Name of Bank for Checking: ________________________ Account #: ______________

Name of Bank for Savings: _________________________ Account #: ______________

Name of Credit Card or Loan: ______________________ Account #: ______________

Names of any co-applicants: ____________________________________________________

I hereby certify that I am over 18 years of age and that the above application is true, complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of information is grounds for eviction.

I also give the landlord or its agents permission to verify all the information given in this application, including past rental information, personal references and employment information provided. I authorize the Landlord to obtain a current credit and criminal background check and contact any of the above mentioned references.

I understand that this application is not a rental agreement and that this application does not create any obligation on the Landlord or its agents.

_________________________________

Applicant's Signature and date