Lease Application

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First Name                Initial                            Last Name              D.O.B             Social Security #

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First Name                Initial                            Last Name              D.O.B             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

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.