Applicant’s Name: ______________________________

Address: _____________________________________

Town/State: ___________________________________

Social Security Number: ________--________--________

Date of Birth: ________/________/________

Occupation: ___________________________________

Monthly Income: _______________________________

Employer’s Name: _______________________________

Employer’s Address _____________________________

Town/State: ___________________________________

Persons to live in unit:  Adults: ______ Children: ______ 

Co-applicant’s Name: ____________________________

Address: _____________________________________

Town/State: ___________________________________

Social Security Number: ________--________--________

Date of Birth: ________/________/________

Occupation: ___________________________________

Monthly Income: _______________________________

Employer’s Name: _______________________________

Employer’s Address _____________________________

Town/State: ___________________________________

Pets:  Dogs: ______ Cats ______ Total Pets: ______

Applicant Interests:  Studio/1 Bath____  1 Bedroom/1 Bath____  2 Bedroom/2 Bath____

Price Range:
$1,300 - $1,450____   $1,450 - $1,600____   $1,600 - $1,800____   $1,800 - $2,000____   $2,000 - $2,250____

Have you ever been evicted?  Yes ______  No ______

Do you currently own or rent?  Own ______  Rent ______

Have you ever filed personal bankruptcy?
Yes ______ (year: ________)    No ______

Current monthly expenses rent/mortgage?  $____________

APPLICANT SIGNATURE:

___________________________________

DATE: ______/______/______

CO-APPLICANT SIGNATURE:

___________________________________

DATE: ______/______/______