Apartment Rental Application Form Page 2
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1
2
3MCR PROPERTY MANAGEMENT, INC.
PAGE 2 OF 3
PROPERTY NAME:
GROTON ESTATES
DATE:
UNIT #
APPLICANT NAME:
Last
First
(M)
BANK REFERENCES:
#
Checking / Savings
Bank
Account Number
Circle one
Branch
City
State
#
Checking / Savings
Bank
Account Number
Circle one
Branch
City
State
GENERAL INFORMATION:
Have you lived in this Apartment Community before?
When?
Do you owe rent to any previous landlord?
[
] NO
[
] YES*
*If YES , to whom?
Amount
Why are you moving from your present address?
Did you give notice? [
] NO
[
] YES
How much notice?
days
Have you ever been evicte [
] NO
[
] YES
If YES, when?
Landlord
Phone # (
)
Have you ever been convicted of a felony?[
] NO
[
] YES
IN CASE OF EMERGENCY CONTACT:
Name (1):
Phone Number:
(
)
Relationship:
Street Address:
City
State
Name (2):
Phone Number:
(
)
Relationship:
Street Address:
City
State
Do you currently have renter's insurance?
[
] NO
[
] YES
If YES, Name of Insurance Company:
#
Policy Number:
IT IS ILLEGAL TO DISCRIMINATE AGAINST ANY PERSON BECAUSE OF RACE, COLOR, RELIGION, SEX,
HANDICAP, FAMILIAL STATUS, OR NATIONAL ORIGIN. MCR PROPERTY MANAGEMENT, INC. &
GROTON ESTATES
PROUDLY ADHERES TO TITLE V111 OF THE CIVIL RIGHTS ACT OF 1974 AND THE
1988 AMENDMENT.
I certify that the above information & the information I've indicated on Page 1, is given freely
and to the best of my knowledge is true. Landlord or his agent is authorized to verify the
accuracy and correctness of these statements and to check my credit & criminal history, as well
as a search for any prior evictions. I expect you to rely on this information, and I agree that if
any information herein contained is false, that any contract made on the strength of this
application may, at your option, be terminated and my application deposit forfeited. I also
understand that this application must be approved before occupancy will be allowed and if not
approved that my application deposit refund will be mailed within 30 days of the date the
application is denied.
SIGNATURE OF APPLICANT'S):
DATE:
DATE:
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