Form Ap-001 - Residential Application Page 2
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2Name: ___________________________Relationship: ___________________Age:_____
Name: ___________________________Relationship: ___________________Age:_____
Pets: Description/Weight
_________________________________________________
Description/Weight
_________________________________________________
Have you ever been evicted? ☐ Yes ☐ No
Foreclosure/Repossession? ☐Yes ☐ No
If yes, explain ________________________________________________________________
Have you ever filed for bankruptcy? ☐ Yes ☐ No
If yes, ☐ Chapter 7 ☐ Chapter 13
If yes, explain ________________________________________________________________
Have you been convicted of a felony? ☐ Yes ☐ No
If yes, explain ________________________________________________________________
In case of emergency, name and address of two nearest relatives not living with you:
Name:
______________________________ Address:___________________________
City:
______________________________ State: ______________ Zip: _________
Relationship: _______________________________Phone Number: (
)_______________
Name:
______________________________ Address: __________________________
City:
______________________________ State: ______________ Zip: _________
Relationship: ______________________________ Phone Number: (
)________________
Applicant has submitted the sum of $__.00, which is a non-refundable payment for a credit check, and processing of this application
by the Landlord or his/her agent. This sum does not represent a rental payment or payment of the lease fee. In the event that this
application is disapproved, or applicant cancels, this sum will be retained by the Landlord to cover the cost of processing this
application as furnished by the applicant.
A reservation payment of $________________ is required for processing this application, and is being paid herewith. By signing this
application the undersigned expressly agrees to rent this unit (if application is approved) and agrees that if applicant(s) is accepted by
management then decides not to move into the premises, this reservation fee will be forfeited as liquidated damages since other
prospective tenants may have been turned away and it may be necessary for Management to re-advertise the property and evaluate
other applicants. If applicant is not approved, all monies given herewith, less application fee shall be returned to applicant. Processing
of applicant shall be as timely as possible and the results may be offered via telephone, fax, or mail.
I certify that the information given herein is complete and correct. The Landlord or his agent is hereby expressly authorized to verify
the accuracy and correctness of these statements, to communicate with my employers, creditors and landlords, and to procure such
other information (including credit reports) which the Landlord may require to evaluate this application at the time application is
submitted and at any time in the future, with regard to any agreement entered into with Management. Any false information will
constitute grounds for rejection of application, or Management may immediately terminate any tenancy entered into in reliance upon
misinformation given on the application.
Signature: ____________________________
Date: __________________________
Page 2 of 2
AP-001 rev. 10-2010
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