Application for Apartment

The following information will be required by the federal government to monitor this owner’s compliance with equal housing opportunity and fair housing laws. The law provides that an applicant may not be discriminated against on the basis of the information supplied below or whether or not the information is furnished.

Your Email *

Name *

First

Last

Date of Birth: *

Social Security Number: *

Phone Number: *

Present Address (street, city, state, zip) *

How did you hear about the apartment community?

Number of Bedrooms desired:

Driver's License #

State:

Do you own a vehicle?

License Plate & State:

Present Landlord:

Landlords Phone:

How long have you lived there?

Present Monthly Rent:

Emergency Contact (Name & Relationship)

Emergency Contact Email:

Emergency Contact Phone Number:

Current Employer:

Address:

Phone Number:

Length of employment with this company:

Gross Annual Wage:

Head of household gross monthly social security amount:

Souse/ other gross monthly social security amount?

SSI/ SSDI Gross Monthly Amount?

Pension amount (gross) per month / Name of Recipient

Pension Fund Name & Address

Are you a Veteran?

Veteran's benefits (amount per month)

Public Assistance Per Month?

Other income (child support, TDI, unemployment or other)

Do you receive regular reoccurring cash gifts from anyone?

Checking Accounts:

List out all banks & current balances below

Stocks, bonds, mutual funds, trust funds, whole life insurance & value/ annual income

accessibility than

Real Estate/ Mobil Homes:

Description/ Address:

Estimated Value & Balance due on Mortgage:

During the past 2 years, have you given away from than $1,000 or disposed of other assets for less than their fair market value

YES or NO - if YES, please explain

What adaptions, if any, will you need in your apartment for accessibility reasons?

please list all

Were you ever the subject of any eviction complaint?

YES or NO - if YES, please explain

Race/ National Origin

Signature / Date