application Name _________________________________ Date of Birth ___________________ Mailing Address _______________________City __________ ST ____ Zip________ Home ph#__________________ Work #_________________ Pager #____________ Mobile#__________________Fax # _______________ Other#__________________ Email ________________________________________________________________ SSN _______________________ Driver License #____________________ ST _____ Children and ages __________________________________________Citizenship__________________ Car Make / Model / Year __________________________ License Plate ___________ Present Landlord ________________________________ Phone _________________ Address _______________________________________ How Long? ____________ Previous Landlord ________________________________Phone ________________ Address _______________________________________ How Long? _____________ 2nd Prev Landlord _______________________________ Phone ________________ Address _______________________________________ How Long? _____________ Nearest Relative _________________________________ phone _________________ Address ______________________________________________________________ Employer ________________________________________ Phone _______________ Position __________________________________________Salary _______________ Address _________________________________________ How Long? ___________ Reference 1 _______________________________________ Phone _______________ Reference 2 _______________________________________ Phone _______________ Reference 3 _______________________________________ Phone _______________ Pets _________________________________________________________________ Bank Name ____________________________________ Acct No ________________ Bank Name ____________________________________ Acct No ________________ VISA (circle) yes/no MC yes/no AMEX yes/no DISC yes/no High School ______________________________ City/ST _______________________ College __________________________________City/ST _______________________ Year(s) Graduated ______________ Degree __________________________________ Ever been Evicted? Y N Ever Been in Litigation with a Landlord? Y N Emergency Contact (Name, Addr, Phone, Relation to You) ________________________ ______________________________________________________________________ Parents’ Name(s) ________________________________________________________ Address(es)_____________________________________________________________ Brothers/Sisters Names ____________________________________________________ The undersigned hereby attest that the above information is true. ______________________________________ Date___________________________