Address:                City, St, Zip:    
                         Months at this address: 

                    Employer:     Months worked     Annual Income: 
               Addr & Ph#    

#2  Spouse Employer     Months worked     Annual Income: 
      # 2  Addr & Ph#    

        Prev  Addr:                          City, St, Zip:      
          E-mail:                                                   Months at this address:        
        
           Day  Phone #:     Area Code                   Cel  Phone:  

              Current Landlord:                          Phone Number:                          Previous  Landlord:                     Phone Number:
          

      Do you have a FEMA CLC Disaster Voucher?    YesNo          Will other people occupy this unit with you? YesNo     
        What is the total number of persons that will reside  in the rental unit?     

        List any other persons below.

             Name                              age                      relationship                 Name                           age                      relationship
            
         
           
           

         Credit References:    At least  2. You must have a major credit card and not have filed for bankruptcy

       Account Name:                           #                         Amt owed                       Monthly payment?
    

        Automobiles that you keep at this address are: 
     

           Closest  relative to contact in case of an emergency:
           Name                                                  Address:                                    Relationship                       Phone #:
     

     I  certify that I am moving from the above current address on good terms and have satisfied all of my lease requirements with my current landlord. I agree upon request to furnish a current credit report on myself and on any other persons named in the lease or that may be allowed to occupy the apt with me.  I agree upon request to furnish a current certification of clear criminal record at my own expense. I further authorize my employer to give out information required for this lease in regards to income, position, and time on the job.  I understand that any lease eventually granted may be voided at landlord’s option if false statements or inaccuracies have been made on this application.  A non refundable application fee of $25 is due with this application.  If a deposit is accepted it is with the understanding that should this application be denied for reasons of credit history, rental history, applicant’s misstatement, or change of mind, that the deposit is forfeit

      By clicking "Submit"  below I agree that I am signing this application with the same effect as if I had done so in person, and agree to all electronic signature regulations. 

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