Duke Barrington
RENTAL APPLICATION
App. #
ALL CO-APPLICANTS 18 YEARS OF AGE AND OLDER
Date Rec.'d
MUST FILL OUT A SEPARATE RENTAL APPLICATION FORM
Time Rec.'d
Phone: (269)-388-9105
Fax:
(269)-388-7062
First Name
Middle Name
Last Name
Street
Email
City
State
Zip
Do You Own?
Rent?
Monthly Payment
Phone (
)
Current Landlord or Mortgage Holder
Name
Phone (
)
Dates From:
To:
Street
City
State
Zip
List all prior addresses held in the last 5 years. Attach additional sheets if necessary.
RENT
or
OWN
(Circle One)
Monthly Payment
Landlord
Phone (
)
Dates From:
To:
Street
City
State
Zip
RENT
or
OWN
(Circle One)
Monthly Payment
Landlord
Phone (
)
Dates From:
To:
Street
City
State
Zip
RENT
or
OWN
(Circle One)
Monthly Payment
Landlord
Phone (
)
Dates From:
To:
Street
City
State
Zip
Sources of Income
Current Employer
Phone (
)
Street
City
State
Zip
Sources of Income other than employer
Total Annual Income
List all persons who will occupy the premises including yourself. Attach additional sheets if necessary.
Relationship to Head of Household
Date of Birth
Social Security #
Full Legal Name
Head
Have you ever been convicted of a felony?
Do you use Medical Marijuana or hold a Medical Marijuana card?
YES
NO
YES
NO
I Have Special Requests
I Request a Barrier-Free Unit
Unit Size Requested
YES
NO
YES
NO
1Bed
2Bed
3Bed
4Bed
Other Accommodations Requested
THE UNDERSIGNED FURTHER REPRESENTS AND WARRANTS THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND AGREES
THAT IF ANY INFORMATION PROVIDED IS FOUND TO BE FALSE OR MISLEADING, THE APPLICATION MAY BE DENIED AND/OR THE
LEASE TERMINATED AT A LATER DATE. THE UNDERSIGNED ALSO AGREES THAT WE HAVE THE RIGHT TO VERIFY ANY AND ALL
INFORMATION GIVEN HEREIN WITH THE APPROPRIATE PERSON OR AGENCY INCLUDING, BUT NOT LIMITED TO, A COMPLETE
CREDIT REPORT AND CRIMINAL HISTORY REPORT FROM ANY AND ALL SOURCES AVAILABLE.
CAUTION: Do not sign this application if it is not completely filled out. Applicants who submit incomplete applications will not be
considered for residency.
Signature of
Date of
Applicant
Application
Professionally managed by:
Office Use Only
Applicant(s) Qualifies For:
Regular Waiting List
Preference List
Unit Size Required
Barrier-Free Unit
Special Needs Unit
Application Approved
Rejection Letter Sent
1822 W. Milham Suite 1A, Portage, MI 49024