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Application and Rental Form

RESIDENTIAL RENTAL APPLICATION

Name of Applicant_________________________________Telephone____________

Present Address________________________________________________________

City, State, Zip Code__________________________________________________

Social Sec. No.______________________Driver's Lic. No._________________

Spouse's Social Sec. No._____________Spouses Driver's Lic. No._________

Birthdate________________ Spouse's Birthdate_____________

How many in your family? Adults____ Children_____ Pets?_______

How long have you lived at the present address?________________________

Name of Landlord_________________________________Telephone_____________

Prior Landlord___________________________________Telephone_____________

Employer_____________________________________Position__________________

How long?________________________________________Telephone_____________

Salary_________________________________________________________________

Name of Bank___________________________________________________________

_____Checking Account No.___________________________

_____Savings Account No.___________________________

Additional Personal/Credit References

Name Relationship Telephone

________________________ ______________________________ _____________

________________________ ______________________________ _____________

________________________ ______________________________ _____________

I represent that the information provided in this application is true to the best of
my knowledge. You are hereby authorized to verify my credit and employment references in
connection with the processing of this application. I acknowledge receipt of a copy of
this application.

Dated:

_______________________________________
Applicant