_________________________________________________________________
First Name
Initial
Last Name
Social Security #
_________________________________________________________________
First Name
Initial
Last Name
Social Security #
_________________________________________________________________
Present Address City
Zip
Phone
How Long
_________________________________________________________________
Previous Address City
Zip
Phone
How Long
_________________________________________________________________
Name and Address of Present Landlord Phone
_________________________________________________________________
Employed By City
Position
Salary
How Long
_________________________________________________________________
Former Employer
City
Position
Salary
How Long
_________________________________________________________________
Co-Applicant Employed By City
Position
Salary How
Long
_________________________________________________________________
Former Employer
City
Position
Salary How
Long
PLEASE FURNISH NAME AND ADDRESS OF BUSINESS
WITH WHOM YOU HAVE HAD CREDIT DEALINGS
_________________________________________________________________
Name
Address
_________________________________________________________________
Name
Address
_________________________________________________________________
Name
Address
_________________________________________________________________
Bank
Branch
Type of Condominium Wanted: [1 Bedroom] [2 Bedroom]
[3 Bedroom]
LIST OF PERSON WHO WILL OCCUPY YOUR CONDO OTHER THAN
YOURSELF
_________________________________________________________________
Name
Age
Relationship
_________________________________________________________________
Name
Age
Relationship
_________________________________________________________________
Name
Age
Relationship
NAME OF PERSON TO NOTIFY IN CASE OF EMERGENCY
_________________________________________________________________
Name City
State
Phone
_________________________________________________________________
Relationship
Date____________/Time_____________ - (I (We) certify that the
preceding information is accurate and complete. I (We)
authorize Central States to make a thorough credit investigation.
_________________________________________________________________
Applicant's Signature
_________________________________________________________________
Applicant's Signature
_________________________________________________________________
Condominium Assigned
_________________________________________________________________
Rental Rate
_________________________________________________________________
Security Deposit
APPLICANT UNDERSTANDS THAT THE RENT DEPOSIT GIVEN WITH THIS
APPLICATION IS REFUNDABLE ONLY IF THIS APPLICATION IS REJECTED
AND FOR NO OTHER REASONS.
