Lease Application

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First Name                Initial                            Last Name              Social Security #

 

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First Name                Initial                            Last Name              Social Security #

 

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Present Address                       City                Zip              Phone            How Long

 

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Previous Address                     City                Zip              Phone            How Long

 

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Name and Address of Present Landlord                                                       Phone

 

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Employed By                   City            Position              Salary                   How Long

 

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Former Employer            City            Position              Salary                   How Long

 

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Co-Applicant Employed By     City            Position             Salary             How Long

 

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Former Employer            City            Position               Salary                  How Long

 

PLEASE FURNISH NAME AND ADDRESS OF BUSINESS WITH WHO YOU HAVE HAD CREDIT DEALINGS

 

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Name                                               Address

 

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Name                                               Address

 

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Name                                               Address

 

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Bank                                                Branch

 

Type of Apartment Wanted:  [1 Bedroom]  [2 Bedroom] [1st Floor] [2nd Floor] [ 3rd Floor]

 

LIST OF PERSON WHO WILL OCCUPY YOUR APARTMENT OTHER THAN YOURSELF

 

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Name                                                         Age                                Relationship

 

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Name                                                        Age                                Relationship

 

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Name                                                        Age                                Relationship

 

NAME OF PERSON TO NOTIFY IN CASE OF EMERGENCY

 

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Name                                          City                           State                          Phone

 

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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.

 

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Applicant's Signature

 

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Applicant's Signature

 

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Apt. Assigned

 

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Rental Rate

 

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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.