Name (include middle)________________________Ph#________ email__________________ SS # _______________ DL #_______________ DOB ________ Education ________________ Present Address _______________________________________________ How long? _______ Rent $ ___________ Reason for Moving ____________________________________________ Owner/Manager Name ____________________________________________Ph#___________ Previous Address_______________________________________________ How long?_______ Rent $ ___________ Reason for Moving ____________________________________________ Owner/Manager Name ____________________________________________Ph#___________ Occupation __________________ Employer ___________________Hours_________________ Previous Occupation _________________ Employer __________________________________ Vehicle Make __________ Model _________________ Year _________ License ___________ Personal Reference ___________________ Address ____________________Ph# ___________ Emergency Contact ___________________Address ____________________ Ph# ___________ FOR AUTHORIZED CREDIT CHECK: Current Gross Income Per Month (all sources before deductions) $ ________________________ Savings Acct. ____________________________________ Acct. #_(last 4 digits)_______________ Checking Acct.___________________________________ Acct. #_(last 4 digits)_______________ Major Credit Card __________ Acct No. (last 4 digits) ______________________________ Credit Score ____________________________________ HAVE YOU EVER.. filed bankruptcy? ________ been evicted? _______ been convicted of a felony? ____________ I declare that the statements above are true and correct. I authorize verification of my references and credit as they relate to my tenancy and to future rent collection. Date _________________ Signed ___________________________________________
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